Mastopexy or augmentation alone
Both doctors could be right.... it depends on the look you want. Can you submit photos? That would really help determine what we think would look best on you.
Reasons for needing a mastopexy
First of all, breast implants will not raise the nipple and areola, they basically just make you a bigger version of yourself. So, if the nipples have drifted down to near, at, or below the crease below the breast or are pointing downward, a lift will make them look better and more youthful. But there are scars involved so some doctors are reluctant to recommend this to you especially as the costs will aslo be higher. In this economy, some doctors tend to tell you what they think you want to hear (no lift needed) rather than what you need to hear (showing you photos of implants with no lifts in folks who needed lifts to see if you like the look).
Thank you for the question and pictures.
I can see why you have received different opinions offered by different doctors. I think my recommendation would be some type of breast lifting in combination with breast augmentation surgery. I would have to examine/ make measurements/discuss goals before I could be more specific about the breast lifting operation that would best meet your goals.
Please make sure your consulting with well experienced board-certified plastic surgeons.
I hope this helps.
How Do I Know if I Need a Mastopexy
It can be confusing as a patient when you get three different opinions however, this probably means that you have a borderline situation. To determine what procedure would be best we have to determine the position of the nipple relative to the infra mammary fold. The infra mammary fold is the line that is created where the breast meets the chest wall. If your nipple is below this line and you have a breast augmentation your breast will look like a "rock in a sock.' In this situation you would require a breast lift to obtain a nice result. If the nipple is above the infra mammary crease then you would be a good candidate for a breast augmentation alone. If you are borderline (which I suspect) you could certainly go ahead and have the breast augmentation as long as you realize that you may have to undergo a breast lift later if you are not happy with the appearance.
First of all, you have done the right thing by getting several consultations and it is not surprising that you have gotten a different opinion from each. That probably means that your are in that borderline situation where you don't absolutely have to have a lift but it may be recommended to position the nipple and areola higher on the breast. Make sure that you are seeing surgeons who are certified by the American Board of Plastic Surgery and one who is very experienced in breast surgery. Members of the American Society for Aesthetic Plastic Surgery tend to have more experience in cosmetic surgery which may help you make your decision. Definitely look at their before and after photographs and make sure that you like the results of the surgeon you pick.
If you get implants alone without a lift, do not expect to get a lift with surgery and go into it with the idea that you may choose to go back and have a lift done later.
Deciding between lift options and augmentation is a personal choice
The most important decision for a woman contemplating a breast lift or augmentation is: "..What do I want to look like?". Once that decision has been made, with the help of visual materials, then it is the time to find a Doctor who is able to produce the specific desired outcome starting with each woman's unique anatomy.
Plastic Surgery is the quintessential surgical craft, based on technology and medicine, but each and every individual outcome is the product of the single surgeon performing it, not a particular technique.
It is hard for a patient to make decisions like "picking" a Doctor on the basis of a particular technique. It is best to review a Doctor's outcomes with previous patients that have a given starting anatomy. Spending a little time in this process will reveal a lot about possible outcomes and decrease "Doctor Picking Anxiety".
Better Understanding Breast Augmentation and Breast Lift
Different surgeons have different approaches, as your story illustrates. This may be confusing at times, but can also be helpful in that it will make you think more critically about your goals and what you want to achieve. Ultimately, you should be better informed and able to make the decision that best fits your needs. Different recommendations are related to varying experience and preferences among physicians. With respect to breast lift, I believe there are a number of surgeons who try to avoid doing a lift in combination with an augmentation for two reasons -- because they think the woman won’t accept additional scarring, or because it’s a more technically difficult operation and therefore requires more time / effort and expense.
The major focus of a breast lift is to raise the nipple-areolar complex (NAC) and centralize it over the breast mound, reduce the size of the areola if necessary, and shape the breast by reducing / tightening the breast skin envelope. A breast lift may be performed in conjunction with breast augmentation if the breasts are small or have lost volume and the NAC will be positioned too low following augmentation alone.
"Ptosis" defines the amount of sagging a breast demonstrates, and it is usually graded based upon the position of the nipple in relation to the inframammary fold (IMF). As ptosis develops, the nipple moves inferiorly and the breast tissue overhangs the inframammary fold. The amount of ptosis will determine if a woman should consider a breast lift and this will directly affect the type of lift performed. To get a better idea of the position of the IMF, and whether any ptosis is present, tuck a pencil horizontally under the fold of each breast. A horizontal line through each pencil marks the position of each IMF; it is not uncommon for there to be some small discrepancies in position when comparing the right and left sides. If one or both nipples sag below the line of the inframammary fold you are a candidate for a breast lift.
For patients with only a small amount of volume loss and droop, augmentation alone may be sufficient for increasing breast size and re-establishing a more centralized NAC position. In a mildly deflated breast, the breast implant increases breast volume, and by doing so, raises the relative position of the NAC with respect to the inframammary fold (IMF).
There are some patients who may be considered "borderline” for a breast lift. To avoid the extra scarring associated with the lift, the surgeon can use a larger implant placed in a lower subpectoral or subglandular position; in essence, the implant is allowed to fall down into the breast. The result provides appropriate NAC positioning, but at the cost of a lower hanging breast mound with a moderate amount of the breast (and implant) hanging below the level of the IMF. Over time, many of these women often experience additional skin stretching and thinning, and become unhappy with their result. They ultimately require a breast lift and perhaps a site change to a subpectoral position. The alternative is to perform an augmentation with a lift, positioning the implant above the inframammary fold.
During your consultation it is important to discuss your goals and expectations of breast enhancement. The size and shape of your breasts, the quality of your skin, the amount of breast tissue present, the location of your breast tissue in relation to the IMF, the location of your NAC in relation to the IMF, and the implant volume chosen are all important in determining whether a breast lift is necessary and what type of breast lift technique will be used.
Breast lift techniques are numerous but change and progress as the amount of ptosis increases. Minimal lifting techniques may involve a partial or full circumareolar scar. If additional shaping and transverse tightening of the breast is required a vertical scar is added from the inferior border of the NAC down to the IMF. And, if vertical breast laxity still remains then a transverse scar placed in the IMF is added to finalize the lift.
My goal is to produce the best breast shape possible, and so I don’t hesitate to recommend a lift if I feel it is necessary. It is then up to the patient to decide if she wants to accept my recommendation. A thoughtful and caring surgeon should be able to help you understand the differences in breast shape and NAC position with or without a breast lift, and should be able to guide you during your decision making.
I hope this is helpful. Best wishes. Ken Dembny
Mastopexy and Breast Augmentation
Please re-post your question with photographs of yourself from the front, three quarter, and side views (please look at how photos look on doctor's websites).
This will allow for a more helpful answer.
When you need a breast lift
Need is a relative term, and you only need what you feel is important to you. Generally though lift is about nipple position and we recommend a lift when the nipple is projecting below the breast fold. The nipple is the center of the nipple not the areola. If the nipple is at or slightly above the breast fold the implant will indeed tend to push the nipple upward. If below however the implant will tend to push the nipple lower and the breast will appear more 'mature''. Lift if you must, and beware the scars.
Best of luck,
Different Doctors Have Different Opinions
Without seeing pictures of you I can't make any recommendations but the reason different doctors give different opinions might be related to their degrees of experience (years in practice, where they trained, etc.) and how much breast surgery they do. Typically if the nipple is below the breast crease a lift will be needed. If you are a borderline case just get the augmentation and see if you like the results. You can always add more scars (from a lift) later! Good luck!