Will My Complete Unders Be Too High? Saline. B to D/DD (photo)

As you can see by my photos I have low nipples due to breastfeeding.I do not want a lift, even though my PS recommended one.He wants to do fully under the muscle and I am worried my implants will be too high.Can I ask him to make the pocket low to help center the implant around my nipples?I dont want to look awful.And he seems content that I will just get the lift later only this is not an option for me.Will I look good after the surgery as planned? Will the larger implant saline drop enough?

Doctor Answers 9

Implant position with borderline ptotic breasts

Breast lift scars can be concerning but if your nipples are above a pencil placed in the crease under your breast, you should be able to get a good result without a lift.  Lowering implants can eventually lead to excessive bottoming out or just low appearing breasts on your chest so I advise my patients to avoid that.  Also, since I prefer partial muscle coverage over full coverage, the implant could settle enough so it is no longer covered by muscle.  You should discuss your concerns with your surgeon to help you understand what look you will have through the different procedures you can have and if he/she doesn't want to spend the time to help you, I would suggest finding another surgeon that would.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast Augmentation after Breastfeeding

It is rather common for the breast tissue to atrophy/melt away after breast feeding, which can result in a deflated and saggy appearance. Depending on the amount of breast skin that remains and the position of the nipple, a pleasing and youthful appearance can be achieved with breast augmentation alone, without resorting to the breast lift. In your particular case, judged by the pictures, you can achieve a nice result with breast augmentation alone. Of course a thorough examination in person is needed to confirm this. The technique required to achieve this would be partial sub muscular implant placement. A specific style and size of implant would be required, based on specific measurements of your chest and your breasts. Make sure your surgeon has lots of experience operating on breasts with your type of post-breastfeeding appearance.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.7 out of 5 stars 56 reviews

To lift or not?

I agree with your surgeon that you need a lift and to do the lift at a second procedure is a good option if you are not happy with the implants alone. You may be okay with just the implants, but I think you should have the lift to get the best results.  The scars usually heal nicely when done by an experienced surgeon.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

It's all in the pocket creation

There are certainly consequences to increasing your size to a D/DD and not addressing your extra skin.  In general, the bigger the breast, the lower the nipple.  If your current breast was filled up with something, your nipple would be in the "right place" for that size of a breast.  Filling it up with an implant (I certainly prefer submuscular implants) would involve a dual-plane technique that allows the bottom portion of the implant to fill out the skin on the lower portion of the breast without getting the double-bubble.  The problems with this are: 1. It will be a large implant.  The bigger the implant, the more gravity works on it, the more they will sag out of a bra. 2. Larger implants have a higher risk of capsular contracture.  3. You'll need another sugery someday (maybe within a couple of years) if you're actually looking for a breast that is nice and full in the top without a bra. A smaller implant with a lift will certainly "last longer" but scars are forever.  Just understand what you're getting in to!  Good luck! 

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breast Enhancement

I think your ultimate shape will be better with the scars asscoaited with a lift, I find women who go with an implant alone when they needed a lift are more upset after the operation 

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 72 reviews

Breast Implant Position

In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold.

Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s).

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Breast Implants and Lift

   I would have to agree that you need a lift and implants.  The alternative is to create a lower fold to make the implant sit lower.  However, this will likely create a double bubble.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Implants vs lift

Based solely on your photos, it looks like you need a lift and placing implants as the sole procedure will not lift your breasts.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Will My Complete Unders Be Too High?

Thank you for your question. In the photos it appears that your arms are not at your sides, and the nipples and breasts may have more ptosis (sag) than is apparent on the posted pictures. 

If your surgeon really placed the implants to be centered on the nipples, you would probably have a "double bubble" from compression of the implant by the old breast crease, and the implants might well wind up high anyway. The appearance in that setting would be quite unsatisfying, the the natural breast tissue appearing to hang off the implant.  If you won't consider a lift, think hard before having breast surgery, because a lift may be the only escape from a bad outcome.

Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 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.