Is augmentation enough? (Photos)

At 250lbs I was overflowing a 42DDD. Now at 150lbs I'm in a 32C. As you can see from the pictures I have some ptosis. From what I can tell the nipple does not sit below the breast fold. The distance from stern al notch to the nipple is 25.5 cm. My plan is to have a form table silicone implant done March placed under the muscle. Can you say if you believe this will correct the sagging? Or will I need a breast lift as well? Thank you in advance.

Doctor Answers 16


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Based on your photos I do not think a lift will be needed. Your nipple is well above the fold and the lower pole that is should come up with the added volume of the implant.

Breast implants do not lift breasts

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Thank you for your question and helpful photos. I'm afraid your breasts are too low for breast implants alone to correct their position on your chest. In order to avoid the double bubble look associated with implants without a lift; your surgeon will need to place the implants partially under the muscle. This maneuver requires your surgeon to cut the muscle in order to place it behind your breast. FYI, your photo clearly shows your chest muscles begin and end above the level of your breasts. Once the muscle is cut, there is nothing holding your implants in place. Implants typically fall out on the sides where the muscle has been cut. Please view the breast revision picture gallery on this site to view what this looks like. Don't be fooled into larger implants in order to "take up the slack" to avoid a lift. You need a lift to move your entire breast footprint back to its original position - directly above your chest muscles. There is a lift that is very powerful and does just that. I've attached an example of what this current method can actually do. This patient underwent The Horndeski Method breast lift without implants and without the vertical scar. I hope this helps. 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Is augmentation enough?

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Augmentation may be enough however, secondary to your history of weight loss and subsequent ptosis you may benefit from a mastopexy (lift) for the most optimal and lasting result.

Dr Kayser

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Thank you for your question. There are a number of issues that are present. The first includes the deflation of the breast from the weight loss which can be replaced with an implant. This could be performed without a breast lift because, as you noticed, the nipple does just sit at the level of the fold. The more relevant concern, however, is the position of your breast on your chest which is referred to as the breast footprint. Your footprint is very low and will present the biggest challenge with your long-term outcome since this can not really be changed. A breast lift would reposition the nipple to a slightly higher position relative to the fold, but it is the position of the fold that will determine where the final implant and breast augmentation will be set. It is important to understand this limitation as any expectations of a breast that is placed higher on your chest will likely be met with disappointment. Your plastic surgeon should know this and I would consult with an experienced surgeon who can discuss this further with you. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
5.0 out of 5 stars 43 reviews

Is augmentation enough?

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You may be OK with implants alone. Your weight loss suggests you may have loose skin which may stretch over time. So a lift may be needed later. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Is augmentation enough?

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Thank you for your question and congratulations on your weight loss.  An augmentation may be enough for a good result in your case as your nipple seems to be above your fold.  However, an in-person examination would be necessary to say for certain.  Your nipples should be centered over the most projecting part of your implants/breasts following the procedure and implants really don't correct any degree of sagging.  Hope this helps.  Please discuss further with your surgeon.  Best wishes!

Many options available to enhance your breasts

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Congrats on your weight loss!  You have nice breast volume and shape, that leaves you with many different options on how to enhance your breasts:

  1. Breast lift alone
  2. Breast lift with a small implant (one operation)
  3. Breast lift with a larger implant (2 separate procedures)
  4. Breast implant alone

The final decision will need to be made after a detailed consultation with a Board Certified Plastic Surgeon who performs breast implant surgery frequently.  This would include an in depth conversation about the risks and complications, scars, cost, down time and your desires.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 83 reviews

Breast augmentation and breast lift

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As you have correctly observed, your nipples do not appear to be below your breast folds.  A breast augmentation alone, without a lift, is usually all that is indicated in these cases. 

Arnold S. Breitbart, MD, FACS
Long Island Plastic Surgeon
4.8 out of 5 stars 160 reviews

Breast augmentation and lift, some advices:

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Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 400-500ml will be excelent on you, to fill the breasts properly.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 372 reviews

Implants alone or will I need a lift ?

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Thanks for your question and the photos. Lifts are not just about the droop, but they are about the quality of the skin as well. From the nipple position an implant alone may be enough. You would likely still have a lower nipple position and still have some droop which I think is more natural. It is the skin quality I can not evaluate here, and sometimes a massive weight loss patient will have more droop than expected.  When in doubt it is reasonable to place the implant, allow it to drop and settle for about six months and then decide upon a lift. Lifts can always be added later.

I hope this helps.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 115 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.