Lift with 700cc-800 cc - over or under muscle? (Photo)

Lift and augmentation with implants are two mutually exclusive procedures. Based on the limited photos posted - It appears that you a candidate for an extended mastopexy/lift with possible reduction- as you already sufficient breast volume. A smaller implant can be placed at the time of a lift, but not 700-800cc .

700-800 cc implants would never fit under the muscle and would extrude inferior and laterally. If you want something this large then it would have to be in front of the muscle. Implants this large placed in front of the muscle will stretch the skin and will descend down the chest wall. I recommend a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

The implant sizes you mention are quite large. In your case I would just do the lift first and then add implants at a second stage. Mire surgeons are doing that these days in cases like yours. You will get a better result with less risk. I would not go above 500’s but that your choice

Most well trained surgeons are more restrictive in terms of implant volume during a single stage lift with an augmentation. This is especially true in patinets needing a significant lift. This is because combing a larger lift with a very large implant can put a great deal of stress on the nipple and can affect blood supply. In patients seeking significant volume increases, I generally recommend undergoing a staged operation with the lift being performed first followed by the breast augmentation as a second surgery. this decreases the risk of nipple necrosis and sets the foundation/breast shape prior to a larger increase in volume that comes with a larger implant. I would caution you from trying to pursue this as a single-stage operation.
Sean Fisher Aesthetic Plastic SurgeonSeattle, WA

With lifts, I prefer to place the implants behind the muscle for better upper breast fullness and more support for the weight of the implants. With such heavy implants as 700-800 cc's, the implant may drop behind the muscle. I do not recommend going with such a heavy size as 700-800 cc's for you. This volume will just give you larger and still sagging breasts. The wish photos you show are not pretty breasts and just sag. Plus that size will stretch and thin your own tissue a fair amount. If you choose that size, there is no point in doing a lift since it will not hold. Big breasts sitting on your lap are not pretty.

Based on your nicely posted photos, it is best to do your uplift as stage one surgery, weight 3 to 6 months for over inflated breast implants for oversize implantation results. It is very difficult to achieve a lift with an oversize implants without having the incisions break open. Best to seek in person or virtual consultations for better explanation. Expect fees to be the eight to $20,000 range for both surgeries.

There are three variables that determine the outcome of breast augmentation surgery.
The first is the patient candidacy for the procedure in the first place. The second is the choice of implants in regards to size, shape and type.
The third variable is the surgeons ability to place the implant in the correct anatomic location.
Augmentation, combined with a breast lift, has a higher incidence of complications, and this can be minimized by choosing to place the implant under the pectoralis muscle.
It is not a good idea to do a breast lift and place the implant above the muscle in a single procedure.
Different plastic surgeons will have different methods of guiding patients through implant selection.
Some providers do this better than others.
Using excessively large implants, increases the chance of undesirable side effects, complications, and need for revision surgery.
Likewise, there are a variety of factors that influence the outcome of breast lift surgery, including various skin design patterns.
There isn’t a whole lot of patience can do regarding their own candidacy.
Implant selection is done with your provider.
By far the biggest variable that patients do have control over is provider selection.
Being board-certified in plastic surgery with years of experience in an overall good reputation, does not mean a plastic surgeon has mastered breast augmentation surgery.
There are substantial differences among different providers when it comes to quality outcomes and minimizing, the chance of complications and the need for revision surgery.
To find the right provider I suggest patient start the process by having multiple in person consultations with providers in their community, who have a proven track record of doing a lot of breast surgery.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own.
It’s a good idea to bring pictures of yourself to use as a reference during the consultation or anytime you are reviewing before and after pictures.
An experience provider should have no difficulty showing you the before, and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what averageResults look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually done.
There’s no correct number of consultations needed to find the best provider.
The more consultations you have the more likely you are to find the better provider.
Ask each provider what their most common reason for doing revision surgery is, what their revision rates are, and what their revision policy is.
Implant selection is an important part of the decision making process.
Some providers will ask patients to make the final decision regarding implants and other providers will make the decision based on input from the patient.
My personal preference is to work extensively with photographs, especially before, and after pictures of previous patient who had similar body characteristics.
Once I have a good understanding of what the patient is hoping to achieve, I bring those pictures with me to the operating room.
I use temporary sizers during surgery to determine what size implants will give an outcome that is consistent with what the patient was hoping to achieve.
I typically have a full selection of implants available to me during surgery and select the implants based on the use of temporary sizers during surgery.
I found this to be the most accurate way of choosing implants for consistent high patient satisfaction.
Different providers will do this differently, and some providers are better at it than others.
Best,
Mats Hagstrom, MD