Do I need a donut lift? Or would implants alone work? (Photo)

My BA is set November 18th to have 420 cc moderate smooth round Natrelle silicone gel implants under the muscle with a donut incision. I've breastfed 3 children, my right breast was the major milk maker, and it shows. My surgeon recommended only the donut incision on the right side, but I prefer to have matching breasts (scars), so he agreed to reduce the areola on both sides, more so on the right.

Doctor Answers 11

In My Deflated Breast Situation, Would Implants Alone Work Or Do I need A Lift As Well?

You have asymmetric breasts, asymmetric nipples, and on the right, you have "0" degree ptosis and on the left, you have "1st" degree ptosis.  With all this going on, the real question is, What do you want to fix?

If you are only concerned about size, then asymmetric breast implants should accomplish a relatively equal volume in both your breasts.  On the other hand, if you are looking for equal breasts with relatively similar sized nipple areolar complexes and relatively even positions, then I recommend implants plus lift. 

I totally agree with you that the two nipple areolar complexes both need reduction.  Secondarily, since there is more droop on your smaller left side than on your larger right side, I think your idea of a 2-sided areolar reduction lift is very appropriate.  In my practice in Hawaii, we do medical tattooing of nipple pigment over circumareolar breast scars at 120 days after surgery which camouflages the lift scar. 

Thank you for your pictures.  They are very informative, and as a complete aside, I noticed you have fatty deposits just at the front of your armpits.  These are the degenerated breast tissue which are unaesthetic, and at least in my practice, we suction these out at the time of surgery. 

Donut lift may not be necessary, so why not do it on both sides?

I think your surgeon is trying to avoid the potential dissatisfaction of an unhappy result by doing what may not be necessary rather than performing augmentation alone, letting things soften, settle, and drop, and then assessing whether or not any kind of lift is needed. This may be because he prefers a periareolar incision for augmentation, but I would recommend an inframammary incision to avoid the ducts and bacteria that could cause higher risk of developing capsular contracture (even with the use of a Keller Funnel).

In "borderline" cases (and you may not even be borderline since your nipples appear to be above your inframammary crease position--try the pencil test), I would counsel implants alone to "fill" your loose skin, allow proper 6-12 months of healing, and then reassess if any sort of lift is necessary. Sure, that's another operation, but better, IMHO, than "automatically" performing both implants plus lift at the same setting.

You might benefit from one or two more consultations to see if a consensus can be reached, and a plan that you can be most comfortable with. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

Breast Augmentatio And Breast Lift Options

Your pictures demonstrate bilateral breast hypoplasia with associated breast sag. They also demonstrate breast asymmetry with your right breast having more volume and sag than your left breast.

A variety of treatment options are available to correct these problems. Unfortunately, they all involve a series of trade offs. The option chosen will, therefore, depend upon the patient's aesthetic goals and priorities.

If perfect symmetry is the primary goal, some type of breast lift will be necessary. Depending upon the physical examination, a donut lift might be a good option. This procedure would lift the breasts into normal position, correct asymmetry of breast volume and areola size. It can be easily combined with a sub-muscular breast augmentation. Unfortunately, this procedure would involve additional scarring.

When the avoidance of additional scarring is a priority, bilateral breast augmentation utilizing a dual plane technique can help avoid a breast lift procedure. Under these circumstances, this procedure avoids additional scarring, but doesn't totally correct breast asymmetry.

Both options have advantages and disadvantages. The choice will ultimately depend upon the patient's priorities and aesthetic goals. It's, therefore, important to thoroughly discuss your options with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Do I need a donut lift? Or would implants alone work? (Photo)

Thanks for your question.

Based on your photos I Believe you are a great candidate to get a Breast Augmentation without doing the Lift and you will achieve the natural look that.

Many surgeons offer online virtual consultations where you send your photos and medical history information so that you can receive accurate cost at no cost to you.

Choose a board certified plastic surgeon who has done a ton of Breast Augmentation and has privileges to do this surgery at a local university hospital. This says his credentials have been checked out by fellow Drs. All surgeries carry risk, talk to your plastic surgeon and choose one wisely.

Reasonable treatment plan

Thank you for pictures. I agree with your surgeon that a donut mastopexy and breast augmentation will give you the best breast shape and size.

Do I need a donut lift? Or would implants alone work?

Thank you for those pictures. Since your NAC is still above your infra mammary line, implants alone will do the job. Those can be inserted through many incisions including the infra mammary incision. If you want to have areolar reduction, then using a peri areolar incision is indicated. You will not need any other kind of lift whether donut or vertical scar. I have one concern though; the size of the implant you chose is very big. You will end up with a cup D Breast at least. Are you ready for this size and weight you are adding to your breast? Ask to use sizers before the surgery to make sure what looks best on you and what suits your body habits.

Best of luck,

Shady Hayek, M.D.
Beirut, Lebanon

Shady Hayek, MD
Lebanon Plastic Surgeon
5.0 out of 5 stars 11 reviews

Lift vs aug

Be very wary of the doughnut lift! These often stretch out and give you large areolas with bad scars!  The vertical component takes the tension off the areola and keeps it from stretching out. In my practice we put the implants through the underarm so there is no scar on your breast. 
Dr Ennis
Destin, Fl

Do I need a donut lift? Or would implants alone work?

I might try a larger implant in 500 cc range than do a secondary donut lift operation under local anesthesia after 3 months from augmentation... 

Do I need a donut lift? Or would implants alone work?

Thank you for the question and pictures. It is difficult to give you  specific advice based on the limited photographs. Your situation is certainly “borderline”; depending on your personal goals ( best discussed in front of a full-length mirror with the help of goal photos), I think you could go either way. My best suggestion: select your plastic surgeon carefully, communicate your goals carefully, and allow your plastic surgeon to guide you. Best wishes.

Lift or no lift

I believe that based on your photos I would recommend a donut lift at the time of surgery. The 420cc is a nice sized implant, and that may correct your sagging. I would discuss this with your surgeon, and leave them the option of performing the lift if the implant did not totally correct the sagging. It can be performed later however. 

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 18 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.