How bad is my sagging? Can I get implants only without a breast lift? (photo)

Question

How bad are my breasts in terms of sagging ? Can I get implants only without a breast lift? My goal is to to have big but natural looking breasts. I pass the 'pencil under the breast test"

Finny George, MD · Answer

Hi, thank you for sharing your question. Implants alone may be able to correct the problem but there appears to be nipple asymmetry which may require a small lift. An in person evaluation will help.

Daniel Barrett, MD · Answer

Dear kickie9,

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

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

Gary M. Horndeski, MD · Answer

You're sagging is not bad. However, your biggest problem is your breasts are widely separated and you have no cleavage. In terms of implants, you will need very broad based implants, not high profile but a round profile. You will also need more medial dissection. I recommend a circumareola approach to reposition the nipple-areola complex slightly higher and more medially. At the same time, implants can be placed submuscular. You may also benefit from fat transfers at the same time.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

From the photos you would have the best results from an augmentation with a lift.  The augmentation would add the volume you desire.  The lift would help with asymmetry and reduce the areola size.  See a board certified plastic surgeon near you to learn more.

Connie Hiers, MD, FACS · Answer

Measurements are needed to be certain, but you probably do not need a lift. Your breasts are spaced somewhat widely apart, and you will remain this way. The bases of your breasts cannot be moved. Wider implants can help decrease this gap some. Please do not go too large for your frame and tissue or you will just sag over time.

Mats Hagstrom, MD (license on probation) · Answer

The good news is that at least according to your pictures and my opinion, you do not need a breast lift.
The not such great news is that your candidacy for breast augmentation is a bit limited based on the breast position on your chest wall.
This doesn’t necessarily mean you can’t have breast augmentation, but you should be aware of this if you’re going to have surgery.
Your breast sit wide on your chest wall.
They’re closer to your armpit than they are to the midline.
You have breast position on your chest wall will be amplified with the projection of implants. The bigger than implant the more this becomes obvious.
This is especially true if high profile implants are selected.
When breast sit wide on the chest while the surgeon has to make some decisions.
If the implant is centered on the breast, then the breast position on the chest wall becomes really obvious.
 if the surgeon puts the implants more towards the center than the nipple won’t be centered on the implant.
If you move forward and have consultations, then this should be brought up if not by the surgeon then by you.
When you look at before and after pictures, make sure you find and look at previous patient whose breast position was the same as yours.
This is the best way to understand what your results are likely to look like.
 Breast augmentation surgery is generally based on three variables.
The first is patient candidacy.
The second is implant selection.
The third is the surgeons ability to put the implant in the correct anatomic location.
Your nipples are fairly forward facing and that makes you a better candidate than if your nipples were divergent.
Your surgeon should explain your candidacy for the procedure and ideally show you pictures of previous patients who had the same candidacy for augmentation that you do.
You should also have a clear understanding of what their approach would be to implant placement in regards to centering the implant on the nipple or placing them more towards the midline. 
I hope my response wasn’t too mumbled or overwhelming.
I see potential disappointment on a regular basis when patients are not ideal candidates for breast augmentation, and are never told of this before the procedure.
You need to understand what your results are going to look like otherwise you may feel at your surgeon didn’t do a good job when equality outcome may have been difficult in the first place.
Again, you can definitely have breast implants and I don’t think you need a breast lift.
It’s important to understand what the procedure can and cannot accomplish.
Best,
Mats Hagstrom M
This response was dictated.
My apologies for potential grammatical errors or the rambling nature.

How bad is my sagging? Can I get implants only without a breast lift? (photo)

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