Mini Lift with Breast Implant Downsize to Correct Sag?

I had 350 cc breast implants about 3 years ago. Always felt they were too large. I have since had a baby and now I really hate them. They are too large and too saggy. Especially the left. I don't want major scars. My ps had recommended replacing the implants with 250 cc's with a mini lift through the areola. Do you think a mini lift will be enough or what do you feel needs to be done? Please help.

Doctor Answers 15

Breast lifts and implants

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It is important to understand and accept what lifts do and do not do and what implants do and do not do. They are two different procedures that do different things.

Breast lifts (mastopexy), properly done, only lift or shift the breast up on the chest and do not fill in, fill out, tighten the skin or breast, or give it tone or perkiness. Mini-lifts are an attempt to lift the breast through limited incisions but do little to actually lift the breast and only seem to be beneficial in breasts that really didn't need much of a lift. Properly done, lifts require some skin removal like a dart in clothing taken in and the current best way to do this is with a "lollipop" or vertical type approach.

Breast implants do not lift the breast. Smaller implants don't make the breast sag and larger implants don't lift them. Sometimes they can give the appearance of lift if the lower part of the breast is filled out with an implant but implants are only pillow volume and the size or fill of the breast from behind is the only issue and separate from the issue of position of the breast.

Based on the picture provided, it looks as if the implant used was too big in an attempt to lift the breast which only made it a too big and saggy breast. If the implant is scaled down it should be about the same width but a lower profile and therefore a smaller volume. This will do nothing for the degree of sag (ptosis). It appears the breasts are too ptotic for anything other than a true lift (mastopexy) and this will require an incision around the areola and from the areola down to the crease below the breast. This can be done along with changing the implant but doing both at the same time makes it harder to judge the resulting size/shape/effect of the change.

Boulder Plastic Surgeon

Breast Lift Scars- focus on the QUALITY

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Hi there-

I understand your concerns for the appearance of breast lift scars...

But rather than have an operation which will almost certainly result in breasts you hate, just so you can have a cute little scar, I would suggest you find a surgeon who can show you photos of breast lift scars (after the scar maturation process is complete- about a year after surgery) that would be acceptable to you.

I always ask my patients- if you end up with breast that look funny, will you be happy because you also got a short, cute scar? I doubt it.

Almost all women would rather have breasts that are beautiful, if they could also have scars that may be longer, but fade to a very thin and inconspicuous line.

I am always actually a bit concerned that there are surgeons willing to do operations on women not because it is what is in the patient's best interests, but because it is the operation she wants and they want her to choose them.

Sometimes doing the right thing means telling people that what they want will probably not make them happy.

Mini-lift with downsizing of breast implants

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Although mini-lifts are great operations in the right candidates, your photos suggest that you need more than a mini-lift. Not only do the areolas need to be lifted on the breast mound, but you have a significant excess of skin between the areola and the fold at the base of the breast - this usually requires a vertical incision to corect this.

Nobody wants scars - I've never had a patient ask me to give them more scars than they require. That being said, not making the necessary incisions usually leads to a suboptimal result.

Hope this helps. Best of luck.

Focus on your desired size and shape

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Approximately 7 years ago, I noticed a trend in my practice: women requested smaller, perky, "yoga" size breasts.  While it may be a case of self-selection, the "beautiful B" has remained in high demand.  In your case, your nipples are large and laterally displaced, the volume of the breasts are low on the chest wall and the shape is elongated, rather than round. 

Given these conditions, I would definitely recommend downsizing the implant, possibly changing the style to a narrower base diameter and choose a full lift, which would facilitate reduction of the diameter of the nipple-areolar complex, as well as repositioning of it both upwards and inwards.  While downsizing the implant alone would reduce the volume, the limited incision mastopexy/lifts, would not definitively achieve the other criteria.  At the end of the day, you should consider whether reducing the scar length is more important than not achieving your aesthetic ideals.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Result of Breast Augmentation and Subsequent Pregnancy

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Your condition is seen several times a day in most plastic surgeons' offices. The same petite women who on the ill-educated advice of their friends insisted and received implants that were too large, often present a few years later with significant breast sagging (aided by gravity and time) asking for another ill-advised procedure to turn back the hands of time.

Unfortunately, this is rarely possible.

The shape of the breast depends on the interaction of several factors, most importantly the area of the breast (skin) envelope and the volume (with or without implant) of the breast. Large breasts ALWAYS sag because the skin ALWAYS stretches. As it does, there is more skin than volume, the breast (Cooper's) ligaments give and the sagging proceeds towards the Rock in a Sock look.

While reducing the breast volume (IE taking the implant out or decreasing its weight) would make the breasts less heavy, it would NOT magically shrink and do away with the excess skin. Doing so would not be sufficient to pull the breasts up. For YOUR degree of sagging, excess skin needs to be taken BELOW the nipple complex (not so much above it) leaving a vertical scar. Failure to do so would result in a substandard lift with a wide, sunburst scar around the areola.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Mini vs full breast lifts with downsized implants

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Downsizing your implants will make you smaller and less full superiorly but won't cause your breasts to lift themselves. Based on your photo, you need a full breast lift to get the best shape. Lifts are a trade-off of shape for scar and it is a rare patient who will be happy in the end with poor shape in order to have less scar.

Breast lift through areola with breast implants will give good result.

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Of course, it is hard to be sure without examining you, but I think your plastic surgeon is right. Peri areolar breast lift with smaller breast implants. Also implant pockets need to be lowered some.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Mini lift and implant reduction

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First, your photo is not ideal. It is difficult to say how much ptosis you have. Second, I am not sure what a mini breast lift is? Is it a areola lift, or a vertical lift?

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast lift with implant remove and replace.

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From the appearance of your breasts in the photos, I would recommend a vertical lift as the shortest scar breast lift especially if downsizing your implants. This will allow you to reduce the size of the areolae, eliminated excess skin, and elevate the nipples to a satisfactory position.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Typical treatment for sagging breasts is a lift

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It's best to have an examination by your plastic surgeon to determine which surgery would give you the best outcome. A mastopexy (breast lift) raises droopy breasts from one to several inches and excess skin is removed. If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants. If you just want to go bigger, the only way to do that is with implants.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 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.