Needing a Second Breast Lift

Hello CT43,

There are two factors at work that lead to your recurrent sagging.  The first was your skin and soft tissue quality has been comprimised by being heavier previously.  Loss of tissue elasticity due to weight gain is a permanent change and prevents the skin from staying tight after skin tightening procedures.  This loss of tightness is usually not significant, but can present recurrent skin sag in certain situations.

The second issue is you got a breast lift with breasts that may not be 'enormous', but were still in the D cup range.  The problem with breast lifts in larger breasts is that the pressure and weight of the tissue accelerates the recurrent stretching of the skin.  The best looking breasts are gotten from a concurrent breast reduction and breast lift, which removes the heavy, unsupported breast tissue, allowing the new and smaller skin envelope to keep its shape.  Combining this with sub pectoral implants will give an idealized contour.

Performing a single surgery that encompasses breast lift and reduction, in addition to breast augmentation is a complex surgery that requires significant experience and an artistic eye.  Be sure to see a breast specialist who is certified by the American Board of Plastic Surgery and is a member of the the American Society for Aesthetic Plastic Surgery. 

Best of luck!

Congratulations on your significant weight loss and ongoing healthy lifestyle. Yes, once your body has reached a “stable state” further tightening of the skin envelope of the breasts (mastopexy)  will likely be helpful. Most patients who have had significant weight loss also benefit from breast implants to increase fullness of the breasts  as well.

Best wishes.

Recurrent laxity is not too surprising given your history.  If your nipples are still at the right level then I would consider a small implant to better shape your breasts and provide superior fullness.  That will fill out the top part of the breast very nicely.  You may require a small amount of skin tightening as well, depending on the size implant you choose.  If you still have a considerable amount of breast tissue then you could consider the "internal bra" lift but I have found that it doesn't work well in the long run for maintaining that fullness in the upper pole- gravity usually wins! Good luck

If your breast skin has lost elasticity, it is very difficult to fill the superior breast unless you use an implant.  If you are happy with your size and understand the difficulties with superior breast fullness, a repeat lift would tighten your skin and improve the contour.

When the breast is thin and deflated through weight loss, a breast lift will raise and shape the breast, improve the nipple position, though still leave the breast rather soft and flaccid. In addition, to considering a second breast lift, more volume can dramatically improve the breast shape and appearance. The idea of an 'internal' lift is likely to leave the upper scoop and provide less than what even a smaller breast implant might provide.
Best of luck,
peterejohnsonmd