50 pound weight loss - Do I need a lift or can I have just implants with no lift? (Photo)

Question

I’m scheduled for a breast Aug June 16 Motiva over the muscle we don’t know what size yet or profile I think we’re going to do on table sizing but I’m aiming for a small d look full c . I’ve lost 50lb and lost a good amount of breast volume . I have no upper pole fullness and have grade 1-2 sag but I feel as my nipples still sit the same as before pretty centered in my opinion. I’ve been to two drs. One recommended a donut lift and the other recommended a lollipop and both want an internal mesh bra . I really really want to avoid that lollipop scar and just do implants and mesh bra and get away with it . I don’t mind looking the perky est . I just want to not regret getting a lift and if my boobs are a mandatory lift kind pls help

Gary M. Horndeski, MD · Answer

Your breasts are low on the chest wall and widely separated. I recommend a breast lift using the Bellesoma. 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.

Best Wishes,

Gary Horndeski, M.D.

Semih Yildiz, MD, FEPOBRAS · Answer

In my experience, this is a borderline decision, but implants alone are least predictable when weight loss has left loose skin and low breast volume. Your photo suggests deflation with some lower-pole skin laxity, but the key exam finding is where the nipple sits relative to the fold and how tight the skin envelope is.
Mesh can support the lower pole, but it does not remove extra skin or reliably reposition the nipple. If you strongly want to avoid a lollipop scar, ask your surgeon to show what implant-only, donut lift, and lollipop lift would realistically trade off in shape, areola position, and long-term settling.

Frank Agullo, MD · Answer

Saw a patient last year, 70 pounds down after a sleeve, scheduled for Motiva over the muscle and undecided about adding a lift. I had her stand up and lift her breast straight up in the exam room. The crease underneath, the inframammary fold, is the landmark. Her nipple sat barely below the fold. We did a doughnut lift with the aug. At one year she looks like she never lost the weight, fully restored.

Same year, different patient, similar weight loss, but her nipple was a good two centimeters below the fold and the skin was looser. I pushed for a full mastopexy with the implant. She refused. Six months out the breast tissue bottomed and the nipples pointed down. We did the lift anyway.

It seems you are like the first patient. You could probably get away without a lift, but the nipple will be a little low. A doughnut lift would give the best look.

#StayBeautiful,

@RealDrWorldWide

Daniel Barrett, MD · Answer

Dear Dynamic799841,

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

Vasileios Vasilakis, MD, FACS · Answer

Hello,
Thank you for the question. From the photos, it appears that a lift is not needed.
I wish you the best. 
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

Yily De Los Santos, MD · Answer

After weight loss, it’s very common to lose upper pole fullness and develop some degree of sagging, even when the nipples still appear relatively centered.

The decision to perform a lift is not based only on nipple position, but also on how much excess skin is present and how that skin will behave once implants are placed.

Implants can restore fullness and improve the upper breast, but they do not remove excess skin. In patients with mild laxity, implants alone can sometimes provide an acceptable result, especially if the patient is comfortable with a softer, more natural look rather than a very lifted appearance.

The challenge is that after weight loss, the skin is often more relaxed. That’s why many surgeons recommend some type of lift to prevent the implant from placing additional weight on already stretched tissue over time.

The difference between a donut lift and a lollipop lift usually comes down to how much reshaping the skin truly needs. A lollipop lift generally provides better reshaping when there is more laxity, while a donut lift has limitations in how much lifting and contouring it can achieve.

An internal mesh bra may provide support, but it does not replace a lift when excess skin truly needs to be tightened.

50 pound weight loss - Do I need a lift or can I have just implants with no lift? (Photo)

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