Lift with implants or just lift? (Photo)

I am 23 with no kids. My breasts grew pointing down and saggy. They also grew from a training bra to DD over 3 months and then I gained and lost weight a few times resulting in an "empty" look. I have (almost) decided on getting a lift but now I'm trying to decide on getting an implant as well. My left breast is larger than the right. I don't exactly want larger breasts but the lift will make them appear smaller and I don't want that either..

Doctor Answers 10

Lift with implants or just lift?

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Yours is a common question, and one that seems to generate different answers among my colleagues. In my opinion, this should be a straightforward question to answer, based on your goals and not a surgeon's recommendation.

Your photos show nipples that point downward, short inframammary crease to nipple distances, small but visible asymmetry in breast volume (size), and nice fullness in a brassiere. Breast lifts remove skin to create a tighter skin brassiere and can also shape the breast, improve symmetry (if more tissue is removed from the larger side), and decrease areola size while improving position on the new breast mounds. Except for the removal of tissue from the larger breast to improve symmetry, skin removal for breast lift only should require removal of no more than 30grams of tissue from each breast.

This preserves your present breast size in a higher, tighter skin envelope. But then there's your asymmetry, which would require removal of "extra" tissue form the larger side to create symmetry. Thus, if you are OK with the present size of your smaller breast (minus the one ounce of skin needed to perform a breast lift), a breast lift (full Wise-pattern--anchor type breast lift) would be all that is necessary.

Implants add size, period.

I think it is inappropriate to imply that implants create more upper pole fullness, or make a breast lift "last" longer, or somehow endow the lifted breast with super qualities. Implants simply add volume, and do so with a bit of additional consideration--cost, risk of capsular contracture, malposition, etc. They also allow the plastic surgeon to use different sizes to correct for your asymmetry. Most surgeons would add one implant size to your smaller breast; I would likely add at least two, since visible asymmetry is always more than two tablespoons (30cc). I would also recommend the smallest, lowest profile implants that fit your goals, assuming you do indeed want the larger breasts that (any) implants would create.

So the answer is yours to provide--do you want breasts that are lifted and match your smaller breast size (minus one ounce of skin each), or would going up about one cup size per breast be OK with you? Implants smaller than 200cc would not be recommended since they could act like a golf ball in a bowler hat--not a good match. But, say 200cc in the larger breast (minus that ounce or slightly more tissue if you don't want to go a full cup size larger), and a 260cc implant in the smaller breast (minus its own ounce of skin for the lift) would make a very nice result for you without causing unnecessary strain on the lift suture lines. For several examples of breast lifts plus implants, you can click on the web reference link below, and then look at the gallery for breast lifts only and see if you understand what I'm saying. Take a look at case 3 for an example of breast lifts plus implants NOT to perform.

One other thing to discuss: some plastic surgeons might tell you that removal of tissue and then replacing it with implants is a way of creating more upper pole fullness, or making a breast lift "last" longer. That is absolute balderdash--removal of healthy living tissue and then replacing it with implants designed to mimic that tissue is (IMHO) asinine.

If you have adequate breast volume (size) and need a lift, then remove only the minimum amount of "extra" skin necessary, do the lift skillfully, and you have a breast that is youthful, perky, and the same size as you started (minus that ounce, which is essentially not visible, as I stated earlier--that takes about two ounces)! Implants are wonderful devices, and I perform nearly 200 breast augmentations and lifts plus implants per year. But they DO add cost and potential complication, so if you like your present size (smaller breast), then all you need is a beautifully-designed and well-executed breast lift with removal of skin only from the small breast, and skin plus about 60-80g more tissue from the larger breast.

Otherwise, go with a lift plus small, low profile implants of different sizes to account for and correct your pre-existing asymmetry. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Breast Lift with Augmentation

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In my office, I see young women that come to the office, and the two breasts are very asymmetric. One breast is lower than the other. There may be differences in size. Or there are certain conditions: one’s called tuberous breast deformity, where the breast has a more unusual shape. It may be very narrow at the base on the chest. The whole breast can be very narrow. There are different variations of it. But basically, that’s a growth and development problem that creates a lot of angst for a young woman.

Breasts are often asymmetric. They can be lifted differently. One side can be reduced or the breasts can have different size implants or different amounts of fat added to improve symmetry. Go ahead and contact local surgeons for consultations in the best procedure that would help with both symmetry and size of your breasts. Good luck!

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Breast lift?

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Thank you for your question and photos.  It appears that you would absolutely benefit from a full breast lift.  To add some volume as well, a modestly-sized silicone implant would improve the appearance of your breasts.  Be sure that you are seen in person by a board-certified plastic surgeon who will be able to guide you as to what you can realistically expect from surgery.

Best of luck!

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Lift with implants or just lift?

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You appear to be a good candidate for mastopexy/lift- in order to address the low positioning and asymmetry you're presenting with. It appears you have enough breast tissue to have a pleasing volume after the lift. You could also have a smaller implant paced sub-muscular at the same time as a lift. Seek an experienced Board Certified PS for in person exam

Breast Lift

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Hi Chaines,
First I would decide if you want more children.  A lift alone is fine, and if you wanted to be bigger, you could always do implants later.  No volume is removed during a lift, but your cup size may drop because the skin is tightened.  I linked to some photos below for you.  All the best, Dr. Joe

Lift +/- implants

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The answer depends on your goals. A lift will recenter your nipple areola and provide you a perkier breast shape but it does give the appearance of being a smaller breast.

If you want the same size breast or larger, you should add an implant. Also, a lift may not give you all the upper pole fullness that you desire and an implant is useful for that purpose.

If you are unable to decide or unsure what you want, I would recommend starting with a lift alone and see how much you like it. This may achieve your goals. If it does not, you can always add an implant at a later date. Good luck!

Jennifer Boll, MD
Tempe Plastic Surgeon
5.0 out of 5 stars 14 reviews

Augmentation and Lift?

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You are correct in that a good lift that reshapes the breast will make the breasts appear smaller. However, sometimes patients have enough of their own breast tissue that the change is minimal.  You can always do the lift first ( which you already know you want to do) and see how you like the results.  You do not burn any bridges that way, and can always add the implants down the line if desired.  There are some patients where the lift is large enough that they are not even a candidate to do it all at once anyways.  The best thing to do is to go for a few consultations and see what is recommended.


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If you do not want your breasts to appear smaller, you will have to add an implant.  Also, you can achieve greater upper pole fullness that way.  Certainly, you have enough volume to consider just a lift, but given your constraints, an implant would seem the best solution. 

Ethan Philpott, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

Lift with implants or just lift?

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Thank you for your question and photo. If you do not want larger breasts a lift alone may be your best option. You can always decide later if you want more volume. See below:

Lift with implants or just lift?

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Based on your photos, I recommend implant lift for you.  Now if  could examine you then that might change.  Imlants don't always have to be used to necessarily augment your breasts.  They can be used to help maintain and in some cases change the shape of your breasts.  You will likely need an implant to do a little of both.  So if you are not opposed to getting implants, then that is what I would recommend for you. Hope this helps.
Dr Vasisht

Bhupesh Vasisht, MD
Voorhees Plastic Surgeon
5.0 out of 5 stars 94 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.