Will implants alone achieve my desired rounder and fuller 32d breasts with centered nipples, or is a lift needed? (Photo)

If you are getting breast augmentation with breast implants, the implant will be placed behind the chest muscle in most cases. There are a few exceptions where the breast implant is placed over the chest muscle due to the activity level you may enjoy.
At NorCal Plastic Surgery, we use gummy bear implants, which are smooth, round implants that will enhance the appearance of your natural breast, safely. They are among the safest and most commonly used implants for breast augmentation.
There are also a few options for placement of the incision, such as under the armpit, along the border of the areola, and under the breast. During your initial consultation, we will determine implant placement and incision type.
Breast augmentation can also be achieved with breast fat grafting, which uses liposuction to collect the fat and then small cannulae to graft the fat into the breasts. Many women also combine breast augmentation with a breast lift, which can help improve breast sagging.

You have a very mild tuberous breast--in my practice, I usually treat these with a breast augmentation (dual plane or subfascial, with a few other steps to help round out the breast), and avoiding a lift unless necessary. The nipples often become less puffy as a result of breast augmentation alone, but after the augmentation if you still would like less puffy nipples, I typically do the donut/Benelli lift in a second stage. Combining the augmentation and lift I typically reserve for more pronounced tuberous breasts.

Dear LadyNYC4911,
determining whether you need simply a breast augmentation versus a breast lift 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 a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hello. I would recommend a dual plane 2 breast augmentation with a circumareolar ( Benilli) mastopexy to optimize your results. Based on the photographs provided, you appear to have differences not only on areolar position and size, but also in the location of the inframmary folds. For this reason, I would utilize an infra areolar approach for implant placement rather than placing the incision in the existing folds. This would allow a more precise lowering of the left fold. Estimation of size is best provided with Vectra imaging. I hope this helps.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Hello,

And thank you for the question.

Based on the pictures you provided, you appear to be a good candidate for breast lift with implants procedure. Breast lift (lollipop vs. donut scar) will put your nipples into the correct position, make the areola smaller and allow excess skin to be taken away, giving you a more youthful, firmer and lifted breast appearance.

Some people are a little apprehensive to the full breast lift due to the scars, but typically they do very well and scars fade over time.

Adding a breast implant to the breast lift would add more upper pole fullness and breast volume that you desire.

I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast surgeries to further discuss your options, specific techniques, concerns and expectations. 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.

I hope this helps.
Good luck!

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon
Queens, New York
(516) 833 0309

You've indicated your goals in the photos well, and you'll never get symmetry or nipple areolar complex position on the breast mound without a breast lift. Your larger/lower breast needs a formal mastopexy, and the other might do just fine with a circumareolar with or without a small vertical dart.

You will need a circumareola approach to correct the asymmetry and the nipple-areola complex positions. This is also access to place the implants. At size 32, each 100 cc of implant corresponds to 1 cup size change. To go from a B to a D would require 200 cc implants.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question and photos. An examination in person would be required to properly evaluate you but based on your photos I would not recommend a dual plane implant placement but rather a subfascial placement since this would better achieve redrawing of your breast tissue and adequately camouflage your implant. If the augmentation does not alone correct the puffiness of the areola then a separate circumareolar incision can achieve tightening.

Please consult with an experienced board certified plastic surgeon whose results and reviews resonate with you, and with whom you feel confident. More than one consultation may sometimes be worthwhile. Best of luck to you.

I appreciate your concerns and it appears that you have options. If correction of areola size and modest herniation is a priority, then a donut lift combined with breast augmentation would be your best option. However, in my opinion, placement of the round, smooth silicone implants in a sub-fascial or sub-glandular plane would produce a more pleasing shape than placement under the muscle in your particular case. Placement of the implants over the muscle also provides a modest lift. Come see me or another board-certified plastic surgeon in our area to explore the best options for you. Good luck.