32DDD lift and implant or lift and reduction? (photos)

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a vertical or wise pattern breast lift.    A vertical or wise pattern lift with an
implant can result in a very nice shape if good technique is
used.    The size of the implant is based on your desired
breast size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their
results.   The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Yes, you will benefit from a lift and an implant.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Thank you for your pictures and questions. My first comment is that every single one of your wish pictures shows someone in a push-up bra or some type of support device so none of those people look like that without clothes. So right out of the gate, you need to check your expectations because neither will you after surgery. Second, while you (and everyone else) would like to avoid scars with surgery, to get optimal results you are going to need at least a lollipop scar or perhaps even an anchor scar to get appropriate lifting. I would actually advise you consider doing your surgery in two stages. Get the lift and let that heal completely. Then size yourself for an implant to be placed 3-6 months later. I think this approach gives you the best chance of the outcome you are looking for.Hope this helps!

Dear ravenvictoria,based on your photo, it does look like you will need a breast lift with either anchor or lollipop incision. If you want to get perkier breasts then a breast reduction might be an option. If there is enough breast tissue then you won't need implants. I would suggest you to consult a board-certified plastic surgeon.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 

Member, Am. Society of Plastic Surgery

Considering your size and amount of sag the best result would be a lift with implants.  Avoiding the lollipop and anchor scars leaves us with no good option for a lift and if you want to avoid those scars, better to do just implants alone and wait to see if you want the scars later.
Again, if there is no vertical scar from areola to inframammary fold (beneath the breast) then the amount of breast tissue hanging below the fold will stay about the same.  The anchor scars can be quite limited if a vertical technique is used but you still need the vertical scar.
Again, you may be happy with implants alone and that's worth consideration if you can tolerate being larger.

As you can see, you're getting all kinds of opinions.  Bellasoma sounds fantastic and if they can guarantee their results that they mention, get it in writing and you can avoid the vertical scar.  But why hasn't the Bellasoma been embraced by most plastic surgeons???  If you want fullness on top and perky too, I would recommend a reduction ('reconstruction') with an implant.  Your hanging tissue below your nipple on your side view will want to hang again following a lift procedure.  Removing this with a reduction will provide durability to your procedure BUT more of your breast size is implant and if you have to have them removed for any reason down the road, you will be smaller now.  Best of luck in finding a surgeon that can deliver what you are desiring.

There is no doubt in my mind that if you wan the best result from a breast enhancement I would suggest a breast augmentation and reduction alternative. I would reduce the hanging, saggy tissue and use an implant to provide the best shape and move the nipple areola complexes to a more youthful position. This is a procedure that many surgeons don't feel comfortable with so it is up to you to find a surgeon who has vast experience. There has to be a scar with any lift. In your case it would be lollipop shaped.

Hello Ravenvictoria,
Thanks for your questions and photos. After reviewing your photos and wish photos, I don't think that you need any implants at all to achieve a fantastic result with just a lift.  You do seem to have a moderate amount of ptosis or sag in both breasts - your nipples appear to be sitting a bit below the fold under your breast. There is a new breast lift technique called Bellesoma that seems like it should be a great fit for you. The Bellesoma procedure lifts your breast, preserves the nipple sensation, and looks as full and perky as if an implant had been placed without using any implant, so no need to compromise.  One of the huge positives of this technique is that there is no vertical incision traveling down the front of your breasts. 
Some of the differences between Bellesoma and the traditional breast lift techniques:
-Bellesoma creates upper pole fullness that traditionally needed an implant to achieve.
-There is NO vertical scar, only well-hidden scars in the fold under the breast, and around the areola.
-The breast is dynamically supported by attaching it to the muscle, so there is no recurrence of sagging which are expected with traditional lifts or reductions.
-The entire central portion of the breast is undisturbed, so nipple sensation remains intact and is very unlikely to be compromised.
The procedure is accomplished by using the skin of the lower pole of the breast (the part below the nipple that sits in the bra cup) to shape the whole breast into a perky dome, then straps are made of the extra skin, anchoring it to the underlying chest muscle so that there is virtually no chance of repeat sagging.  The skin that above your nipple and below your collar bone is utilized to cover the perky, lifted dome that has been created and then a new (usually smaller) circular opening for the areola is placed at the high point of the cone, creating your new lifted, full and shapely breast.
From your photos and wish photos, you appear to be a very good candidate for this new technique and should really get the look that you are desiring without implants or unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to who offers the Bellesoma technique to discuss your breast lift
Best wishes!
Dr. Brown

Based on your photos and the look that you are seeking, the only way that could be accomplished would be with a breast lift and implants. You truly do not have enough volume especially where it is need - higher up. In addition, the lift need would most likely require the anchor shape incision as the other approaches would fall short on the ability to contour.Ultimately, you need to see one or more reputable board certified plastic surgeons in consultation and then make a decision based on the information you receive and your experience.Steven Turkeltaub, MD

I am afraid that the look you want (by photos attached)  is a look of an A cup woman with large round implants.  Since you are DDD and want to avoid a lollipop and anchor scars your options are limited.  An implant alone will make you  larger than DDD and a donut mastopexy will not lift you .  Please visit in person with a board-certified plastic surgeon to learn more. Best wishes.