Breast augmentation without a lift after weight/volume loss? (Photos)

Question

I have completed two consultations with board-certified plastic surgeons and have received two different answers. One is saying I would need a breast lift with augmentation and the other is saying a breast augmentation alone. I have lost volume in upper chest since weight loss. I fell in love with a 475cc high profile silicone implant at both of my consults. No kids or breastfeeding in past. Thinking of doing breast augmentation and going from there. Just a little confused now…

Ted Eisenberg, DO, FACOS, FAACS · Answer

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 then get to choose what looks right for them. 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

Richard Zienowicz, MD · Answer

Hello and thank you for your question. Your breasts have some sag, called pseudoptosis, with breast tissue below your breast crease. Without being able to perform measurements, it is hard to say for sure, but I would likely recommend a dual plane submuscular (under the muscle) approach or a sublglandular approach (above the muscle), with a larger implant to fill out the breast tissue and give you the cleavage and volume you want. Good communication with your surgeon is key for you to ensure that your wants and needs are met and that you understand what your options are and what the pros and cons of each possible procedure are. Like others have said, you fall into a "grey area" where you could undergo a breast lift and have perkier breasts, but are left with scarring. You could undergo a breast augmentation, but run the risk of having a double bubble deformity or worsening of sag, among other things. I truly recommend going with a surgeon that fully discusses all options with you and the benefits and risks of each one so you can make an informed decision. Best of luck.

John Michael Thomassen, MD · Answer

If you are doing implants in the 450+ range, you would not need a lift, as the volume of these implants will require all the skin you have.  For smaller devices in the less than 300 cc range, a lift as well would be ideal.  I would recommend a lift alone and not worry about implants.

Gary M. Horndeski, MD · Answer

The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

You are borderline as far as needing a lift but I also think a lift would be preferred. The lollipop lift is perfect for your situation

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on these photos, I do not think that you need a lift and that you are a great candidate for augmentation alone. It will provide you with great volume, projection and shape. I hope this helps.

Scott W. Vann, MD, FACS · Answer

Your nipples are above your breast fold but barely. I think you would do great with a dual plane augmentation without a lift. This would make your breasts larger and fuller but positioned right where they are. They would not be super perky like they would with a lift, but you would not have the cost of scar of a lift. Good luck.

Leland Deane, MD, FACS · Answer

Thanks for your excellent question.
I would suggest augmentation alone. Your breast configuration and nipple position do not warrant, in my opinion, a lifting procedure. You should do well with augmentation. Having said that, the implant size seems high (too much) to me. I'm happy to share like-appearing patients of mine with a virtual consult if you wish.
Best of luck.

Daniel Barrett, MD · Answer

Dear scruggj,
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

Connie Hiers, MD, FACS · Answer

Just based on your photos, you would do well with just an augmentation. However, your breasts naturally sit somewhat low on your chest and will remain in that position. The base of your breasts cannot be changed.