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Larger implants over the muscle or dual plane can give lift in borderline cases. This is an option especially if you are ok with some slight drooping post op.An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.
The rate of sagging you have would probably make a breast lift necessary, since your areolae/nipples are located well below your breast crease. Breast augmentation will enhance this sagging, and the implants may sit too low on your chest. The weight of the implants will also speed up the sagging of your breasts, making a lift inevitable in the nearer future.
Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive (some want smaller less droopy breasts and others want larger less droopy breasts).There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision. A breast augmentation alone may be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.Based upon your photo/description, you would benefit from a lift. However, if your goal is volume only an augmentation may be appropriate. However, you must remember, the implant will not provide a lift. This is irrelevant when clothed and wearing a support garment. In my experience, patients are typically disappointed when they have foregone a lift when it is needed. As long as your expectations have been adjusted, an implant alone is not unreasonable.There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon (ABPS). Patients should discuss their concerns with their physicians in order to make an educated decision.
Breast implants alone will give volume to the breast with a limited lifting of the nipple. For the best cosmetic results in ptosis, frequently augmentation is performed with a breast lift. A breast lift usually is performed at the same time as implant but can be performed later if the drooping is bothersome. Realistic expectations are important. One doesn't want a "snoopy" breast with the natural breast tissue sagging below the breast implant.
Hi flowermom88, Determining whether you need simply a breast implant versus a breast lift or both can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift. These two surgeries can be done at the same time and this may be optimal as the risks can be minimized. In addition, upper pole fullness is achieved with appropriate implant selection but more importantly, submuscular placement, and precise pocket dissection. The submuscular placement allows the muscle to cover the top part of the implant which allows the upper pole to appear fuller. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side. You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals. Daniel Barrett, MD, MHA, MS Certified, American Board of Plastic Surgery Member, American Society of Plastic Surgery Member, American Society of Aesthetic Plastic Surgery
Thank you for your question and posting appropriate pictures. Ideally you would need a lift, however, in some patients and you seem to be a candidate, placement of implants properly in a special position over the muscle can give you an internal lift. Of course you would need a consultation either in person or via Skype/FaceTime for precise recommendations.
Tough to say. You may be able to avoid a lift but it would probably need to be determined during surgery after the implant is in place to see how much it elevates the nipple. If the implant pushes the nipple up enough so that it’s centered then there’s no need for a lift, but if the nipple remains low the breast will look odd without the lift. You’ll have to discuss beforehand with your surgeon what you’re okay with.In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.Best of luck,Keith M. Blechman, MDNew York, NY
Hello and thank you for your question. Thebest advice you can receive is from an in-person consultation. Based onyour photographs, the best shape and contour could be achieved with an implantand a breast lift. Your nipple sits below the inframammary fold andwithout a lift in addition to the implant, this will not have a naturalshape. A breast lift with an implant can result in a very nice shape ifgood technique is used. The size, profile, and shape of theimplant is based on your desired breast size/shape, your chest wallmeasurements, and soft tissue quality. This decision shouldbe based on a detailed discussion with equal input from both youand your surgeon. Make sure you specifically lookat before and after pictures of real patients who have had this surgeryperformed by your surgeon and evaluate their results. The mostimportant aspect is to find a surgeon you are comfortable with. I recommendthat you seek consultation with a qualified board-certified plastic surgeon whocan evaluate you in person.Best wishes and good luck.Richard G. Reish, M.D. FACSHarvard-trained plastic surgeon
Hello and thankyou for your question and photograph. The question ofbreast implants alone vs implants plus a breast lift is a question I hearquite often, and with a fairly simple answer. Here it is... If you want toincrease your breast volume AND wants the BEST outcome, then if your nipple is below your breast crease,you will benefit more from a breast lift with implants, and not justan implant. Although an additional profile view of your breasts would be ideal, looking at your breasts from purely an objective manner, one can see that your breastsare deflated, and your nipples are positioned below your breast crease, and that you would benefit the most from a lift WITH implants. However, if you are not unhappy with the position of the nipples and just want improvement in volume as you stated, then you can have a breast augmentation with implants alone, and not a lift. Regardless of the decision you make, there are a numberof important points to discuss about both a breast augmentation and a breast lift.In terms of the breastaugmentation, the first step is to have a detailed discussion to clearly define your desired breast outcomegoals – this would include the size you would like to achieve, and yourideal breast shape. I would then select the best breast implant for youbased on volume of the implant, contents of the implant (saline vssilicone), shape of the implant (round or anatomic), surface of theimplant (smooth or textured), position of the implant (over or under thepectoralis muscle, skin stretch of your breast (more stretch would require alarger volume to fill, as in your breast), degree of breast sag (which wouldbenefit more from a lift), breast diameter and overall chestcircumference, native breast tissue volume, and any history of prior surgery ortrauma to the breast.When it comes to the breastlift, the degree of breast and nipple droop will determine the type of incisionnecessary to lift the breast. An exam inperson would allow me to truly evaluate the "substance" of yourbreast and get a sense of how "full" your breast is, and determinethe type of breast lift you would most benefit from. In terms of the incision, there are manytypes of breast lifts (with different incisions) which include the donut,lollipop, and anchor incisions. For moredetails on each of these breast lifts, please refer to the link below. If your nipples are only 2cm below your fold as you stated, then a donut lift might suffice. However, they may be a little lower, in which case you would likely benefit from a lollipop or from an anchor incision. During both these lifts, a large areolais also re-sized to a smaller areola, a "side benefit" that many ofmy patients enjoy. The next step foryou is to seek out a board certified plastic surgeon who specializes inaesthetic plastic surgery. In your consultation, be sure your surgeonaddresses all your concerns and discusses the surgery details including theposition and size of the incision used, the type of breast implants available,the risks and benefits of the procedure, recovery time, and post-operativecourse. Also, be sure to see plenty of before-and-after pictures in womenwho have a similar breast appearance to yours, and preferably at different timeframes (3 weeks out, 3 months out, etc) to more accurately predict your ownsurgical outcome.And lastly, Ithink the most important component of the consultation is to establish a goodconnection with your plastic surgeon. It’s the connection that allows youto clearly define your desired breastoutcome goals, the first step of this whole process. If you don’t feel youhave a good connection with your plastic surgeon after your consultation,he/she may not be the best surgeon for you.For more information on Breast Lifts, please refer to the link below.Good luck.Mark K Markarian,MD, MSPHHarvard-trained Board Certified AestheticPlastic Surgeon
Implants can be done without a lift when the breasts are deflated more than sagging, which relates to nipple position. With grade 2 ptosis, it is unlikely that you will get a look that you will be happy with long term unless you do a lift with the implants.
Dear foxxymom, Thank you for your question. Your breasts should not feel significantly different in texture in the way you have described. Having one soft breast and one hard breast is not expected this far out from surgery and you should return to your operating surgeon for an in person...
From the photographs it looks as though breast augmentation alone may yield a very good aesthetic result. I think implants in the sub glandular position camouflage ptosis better than implants in a sub muscular position
Nipple hypersensitivity is not uncommon following breast augmentation. This is usually self-limited and disappears over a few weeks. However any change such as this should be addressed by your plastic surgeon who you should see for an in person examination.
