Considering Implants after weight loss, what type/size would I need to achieve this?

Question

A few years ago, I lost a decent amount of weight, and my breasts decreased from a 36D to 34C, along with some noticeable sagging. My desire is to replace my lost volume to a full C/small D. Would I likely need both an implant and a lift to do this? Could I achieve it with just the implant? Based on my goal pictures, about what size/profile does it appear I would need? I want them to appear and feel as natural as possible; is the size increase I want reasonable with them still appearing natural?

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements.  Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant
should be equal to or, more ideally, smaller than the width of your breast. The
breast width is a measurement of how wide your breast is at the base, which
should be measured at the level of the nipple. Choosing an implant that is
smaller in diameter than your breast width will avoid the "side
breast" fullness that is often associated with a more artificial
appearance.  Other than that, you should choose the implant based on
volume, not on the dimensions of the implant.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid silicone
(less cross-linked), if this implant should rupture, it will leak only into the
scar capsule formed around the implant but may cause some discomfort or implant
distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Sheila S. Nazarian, MD · Answer

Choosing the right size implant depends on any number of factors most of which require an in person exam. In terms of the breast lift, you look borderline meaning that you could probably get away with an implant only. Schedule a consultation with a board certified plastic surgeon in your area (link below) to discuss your options. Best, Dr. Nazarian

Jose Perez-Gurri, MD, FACS · Answer

Hi. IMHO you would benefit from a breast augmentation without the need for a breast lift. I would suggest smooth, round silicone gel implants placed through the areola, using the Keller funnel, placed in a partial submuscular position in the range of 425 cc moderate plus profile.I am certified by the American Board of Plastic Surgery and have practiced in the"land of breast implants", Miami, for the past 29 years. I encourage you to look up the surgeon you eventually select and make sure they have years of experience in performing cosmetic breast surgery. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits?How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications.I wish you the best on your journey. I hope that the info provided has been helpful. Should you require any further clarification, do not hesitate to contact our institute. I answer all questions personally, not through patient coordinators or other marketing individuals.In our office we use TouchMD which is a web based program in which patients have the ability to load their picture unto the program. I then evaluate them and can actually draw on the picture to show a potential patient where the incisions would be located and how the procedure is to be realized. It's all done to comply with HIPPA which is the federal law that protects the patient's medical information. Look them up. Dr. PG

Ramiro Morales, Jr., MD · Answer

Thank you for your questions.  It is hard to tell from just your pictures and your goal pictures what size of implant and style would best achieve your goals.  The best thing is for an in person consultation with a Board Certified PS to make the right choice.  One thing I would definitely recommend is that you chose silicone implants.

Keith Hodge, MD · Answer

Looking at your photos, you have a significant amount of breast volume below the breast fold.Therefore, I think you need a breast lift with the augmentation to achieve your desired result. Good luck!

Donald R. Revis Jr, MD · Answer

Good morning!I recommend a round smooth High Profile silicone gel implant placed under the muscle, with a donut mastopexy to lift your nipple position and tighten your skin. Soft, natural, lifted, full!In terms of size, my initial guess is in the 500-600cc range, but we will know for sure when I measure your chest, we review photos together, and you have an opportunity to try on the implant sizers here in the office.I have attached a link to my Breast Augmentation photo gallery for your review- hope it helps!

Andrew P. Amunategui, MD · Answer

Thanks for posting.   Implants are an ideal solution for volume loss.  You can easily get 1-2cm of lift with implant alone in a "deflated" breast (see attached web reference).  Women who need 2-3 cm or more of lift (and it appears that you do NOT) would need formal lift.  I agree silicone will give you a more natural feel/appearance.  Nothing can replace in person consultation with BCPS!  Good luck!!

Gary M. Horndeski, MD · Answer

Hi,Thank you for your question and sharing your photos.Please know that breast implants alone do not and cannot lift breasts. This is a common misconception and misinformation propagated by unscrupulous practitioners. You need a breast lift to properly reshape and re-position your breasts. Also, your 'goal pictures' are of women who have full D/DD breasts. You may be happy with just a lift without the extra cost, risk or maintenance of breast implants. Conventional breast lifts are weak and esthetically unacceptable to women due to the scarring. The Horndeski Method (TM) breast lift is a viable option for women who are happy with their size who want perkier breasts without all the scarring. I hope this helps.Best wishes and kind regards,

Emmanuel Mallol Cotes, MD · Answer

Congratulations on your weight loss!After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 400-450ml will be excelent on you, to fill the breasts properly.Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".Respectfully,Dr. Emmanuel Mallol Cotes.-

Charles Galanis, MD · Answer

Hello and thanks for the questions!  Obviously this forum is no substitute for a thorough examination but hopefully we can provide some information to help you start navigating the process.  Looking at your photos, it is somewhat difficult to differentiate between pseudoptosis (breast sagging lower but nipple at or near appropriate position) and ptosis (essentially breast and nipple sagging lower).  A physical exam could differentiate between these two anatomic diagnosis.  The bottom line is the treatment would be similar but it does depend largely on your goals. In many cases both pseudoptosis and mild ptosis can be addressed with augmentation alone.  However, that would require a large volume implant which may (1) not be what you want and (2) expedite your eventual need for a breast lift in the future. My best guess would be to tell you that if you wanted a large volume augmentation, you might be able to get away with augmentation alone.  However, if you want less augmentation and a more natural look, you might be best suited with a periareolar lift (incisions around the nipple only without the lollipop scars) along with an implant.  Again, an exam would help your surgeon narrow down the right plan for you.Hope this helps!

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