I would like implants put back in but do not want a lift. Possible to add fullness without going back huge? (Photos)

Question

I’m a female age 67 and in excellent health I would like implants put back in but do not want a lift. Possible to add fullness without going back huge? Looking to get it done soon. Thank you. Was a 38DD. Want something a lot smaller like a c cup??

Gerald Minniti, MD, FACS · Answer

There is no reason to avoid the lift you need other than saving money; you already have an anchor scar pattern, and there is little discomfort associated with the lift. Despite having a prior lift, your breasts are sagging again and will behave like any sagging breast you put an implant in without a lift: unattractive and abnormal. Not natural.

Elisa Stein, MD · Answer

PJ23334,There are several factors to consider when deciding on implants with or without a lift. Ideally the implant would fill in the skin envelope to reduce the laxity if you are not having an implant. In your case, that would likely mean going larger than a C cup. The timing of this surgery matters too. I assume you had larger implants removed, and you want to wait enough time for your skin to retract/tighten as much as possible after surgery. This can take from 3-6 months to a year. If you have waited long enough, and only want a C cup worth of implant volume added, then you should consider a lift.
Dr Stein

Daniel Barrett, MD · Answer

Dear pj23334,

determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Leila Kasrai, MD, FRCSC · Answer

Your nipples appear to be located below the line of your breast fold so a lift would be recommended. Without one the implants would sit low on your chest and there wouldn't be any fullness in the upper portion of your breasts.

M. Zakir Sabry, MD · Answer

Thank you for your question. The key issue is that your nipple position and skin laxity almost certainly require a breast lift along with augmentation. Implants alone will restore some upper-pole volume, but they will not reposition the nipple–areola complex or tighten stretched skin, and in fact may worsen sagging by adding weight. During your in-person consultation with a board-certified surgeon, he/she will measure nipple-to-fold distance, assess skin elasticity, and finalize the lift pattern and implant size that will safely achieve your goals.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your photos alone, you might want to consider a revision lift in conjunction with a smaller augmentation in order to better align the native breast tissue with the implant. This is not absolutely necessary and becomes a moot point in a support garment. However, this will be an issue when unsupported. The presence of prior lift scars also mitigates any concern for increased scar burden.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Chet Mays, MD · Answer

Thank you for your inquiry!  We would love to meet with you to discuss your goals. You can also add some fat to the area for additional volume.   Schedule a consult with a Board-Certified Plastic Surgeon to help you reach your goals.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Dino Mendez, MD · Answer

If you want to avoid breast lift incisions, I think you will have an acceptable result, but you breasts will have a mildly lower shape/position. This will be visualized with your bra off, but with bra support, I think things will look youthful. If you want the perkiest, most youthful look, a breast lift would be the way to go, but I'm not sure that is what you are looking for at 67 yrs old

Ira H. Rex III, MD · Answer

Choosing the right operation for you definitely involves discussing your expectations with your plastic surgeon.  What each individual patient is looking for sometimes can or cannot be attained.  I suspect a smaller implant could give you some more upper pole fullness, although you would have to accept the overall result of still having some droop. Good luck!

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