Do I need a breast lift for more perkiness? 2 months post-op revision. (photo)

Hello, So I'm about 9 weeks post op from breast Reaugmentation with 600cc silicone implants. First implants bottomed out and fell laterally so Internal sutures were also placed to keep implants medial. I had mild ptosis before augmentation but PS didn't want me to have the lift scars. This time I asked my PS for more "perkiness." I have so much skin on the bottom but no upper pole fullness + I wanted more dramatic look. Do you think I need a revision with lift to achieve this "perky" look?

Doctor Answers 9

Do I need a breast lift for more perkiness? 2 months post-op revision. (photo)

beauty is in the eye of the beholder. We as surgeon as always should strive to give patients what they want. However, we also need to be frank. In looking at your photos, I feel your results a very acceptable. The fact that that it hasn't met your expectations is different. Your anatomy does not lend itself to have perky breasts such as those seen in an A cup patient who undergoes an augmentation. The bigger that implant the more chance that they will thin out the skin and bottom out. Every time you undertake a surgical intervention you run risks and complications. Be safe and good luck.

Dr. PG

Breast issue

In the photo you post, they look good, they are sitting in the appropriate position own your chest. Trying to force them higher will look unnatural.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Perkiness

With the size of your current implants, they possibly may not sit any higher due to the weight. Going larger will just give your larger breasts that sit where these do or even sag. For perky, you might consider going smaller and doing a lift. I would suggest discussing all your concerns with your surgeon.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Lift or not

Breast Lift with Implants or Implants Alone

One of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask,  “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.

Lift

From what I can see it looks like your nipple is pretty well positioned on your breast, although I cannot see if your nipple is below your breast fold or not. There is a limit to how high any surgeon can keep your implants because of the length of your ribcage, the elasticity of your skin and tissues, and age. Just be aware that the bigger the implants the higher the risk for the implants to bottom out and not be as perky. 

Allen M. Doezie, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 32 reviews

Lift or not

Thank you for the question and from the photos submitted you do not need a lift though you might benefit from an areola reduction which would also act to some degree as a lift.


Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 60 reviews

Do I need a breast lift for more perkiness? 2 months post-op revision.

Without your pre-op photos- it's difficult to give you the best answer. Generally speaking, the word "perkiness" coming from the patient- means- a breast lift. Most non-anchor lift techniques have minimal lift capabilities. The lift and perkiness are defined by the size of the areola AND the nipple position. In most instances- this should measure from the sternal notch to the nipple 21-22 cm. You appear to be longer than that. If you trull want perkier breasts AND 600 cc implants - I would consider implant removal with a lift, wait 3 months and put 600cc in. If you are willing to accept 300-350cc implants - I would consider removing 600cc implants, doing a lift and immediate 300cc implant placement. 

Depends on

if you would want scars from a lift. Your shape is fairly good, if you want more upper pole and projection/volume, then you need a higher profile implant. Only an in person consultation with details of what you have in you currently would help a surgeon answer these questions.

Do I need a breast lift for more perkiness? 2 months post-op revision.

Over the internet to difficult to asses the issues. Though appears volume asymmetry, N/A asymmetry, slight ptosis or pseudo ptosis. I might offer fat grafts to correct volume asymmetry, donut lift to even out N/A complexes. Bt a full or L shaped lift NOT indicated...

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