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

Wayne I. Yamahata, MD · Answer

It is not possible to provide a definitive answer based on your single photo. Your photos suggest that the amount of sagging is mild. My impression therefore is that the benefits of a lift will not outweigh the extra surgery, costs and risks of the procedure.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your (limited) photo, you do not appear to have a significant degree of ptosis/sagging. An augmentation alone may be adequate. Ultimately, there is no replacement for an in-person exam.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Leila Kasrai, MD, FRCSC · Answer

A side photo would be helpful. If your nipples are located below your breast fold, a lift is recommended. Based on your front photo, it may be that a lift is needed.

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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