Can I just get implants with grade 2 ptosis? (Photo)

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

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, MD
New York, NY

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, the best shape and contour could be achieved with an implant
and a breast lift. Your nipple sits below the inframammary fold and
without a lift in addition to the implant, this will not have a natural
shape.  A breast lift with an implant can result in a very nice shape if
good technique is used.  The size, profile, and shape 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.  FACS
Harvard-trained plastic surgeon

Hello and thank
you for your question and photograph. The question of
breast implants alone vs implants plus a breast lift is a question I hear
quite often, and with a fairly simple answer.  Here it is...  If you want to
increase 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 just
an 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 breasts
are 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 number
of important points to discuss about both a breast augmentation and a breast lift.In terms of the breast
augmentation, the first step is to have a detailed discussion to clearly define your desired breast outcome
goals – this would include the size you would like to achieve, and your
ideal breast shape.  I would then select the best breast implant for you
based on volume of the implant, contents of the implant (saline vs
silicone), shape of the implant (round or anatomic), surface of the
implant (smooth or textured), position of the implant (over or under the
pectoralis muscle, skin stretch of your breast (more stretch would require a
larger volume to fill, as in your breast), degree of breast sag (which would
benefit more from a lift), breast diameter and overall chest
circumference, native breast tissue volume, and any history of prior surgery or
trauma to the breast.When it comes to the breast
lift, the degree of breast and nipple droop will determine the type of incision
necessary to lift the breast.  An exam in
person would allow me to truly evaluate the "substance" of your
breast and get a sense of how "full" your breast is, and determine
the type of breast lift you would most benefit from.  In terms of the incision, there are many
types of breast lifts (with different incisions) which include the donut,
lollipop, and anchor incisions.  For more
details 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 areola
is also re-sized to a smaller areola, a "side benefit" that many of
my patients enjoy.  The next step for
you is to seek out a board certified plastic surgeon who specializes in
aesthetic plastic surgery.  In your consultation, be sure your surgeon
addresses all your concerns and discusses the surgery details including the
position and size of the incision used, the type of breast implants available,
the risks and benefits of the procedure, recovery time, and post-operative
course.  Also, be sure to see plenty of before-and-after pictures in women
who have a similar breast appearance to yours, and preferably at different time
frames (3 weeks out, 3 months out, etc) to more accurately predict your own
surgical outcome.And lastly, I
think the most important component of the consultation is to establish a good
connection with your plastic surgeon.  It’s the connection that allows you
to clearly define your desired breast
outcome goals, the first step of this whole process. If you don’t feel you
have 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, MSPH
Harvard-trained Board Certified Aesthetic
Plastic Surgeon

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.

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 flowermom88,Thank you for your question.  Your photo indicates a few things; the ptosis which you are aware of, the size of your areolas is large relative the remaining breast skin, and the volume loss.  to address these I would recommend a Mastopexy (Lift) combined with an implant.  An implant alone will likely leave you with just a larger droopier breast and may stretch the areola to an unacceptable size.  I know the thought of the scarring from a lift can be daunting, but most pt's do very well and are accepting of the trade-off between scars and the better overall shape to the breasts.  Hope this helps & good luckJames Sheridan, MD