Already Have Breast Implants Under Muscle and Now Want Breast Lift (photo)

The previous two answers are confusing for a few reasons so let’s move past those. I think you made a good choice with implants. Although I haven’t seen before photos, I’m assuming the implants provided a substantial boost in volume for you. The difficulty with a lift in your situation isn’t with the implant and their position. Yes, the implants make the skin tighter and a lift would be a little bit easier without implant but then you wouldn’t have volume. The challenge is the lack of excess skin, the large diameter of your areolae, and a short distance from the nipple to inframammary fold. With that, I don’t think a lollipop or anchor incision is an option. Therefore the remaining option would be a donut lift. This type of lifting of the nipple and areola requires skin excision around the areolae which will add to the tension. Excising some of the outer rim of areolae (donut) to make it smaller will result in more tension. Tension isn’t good for scars or the areolae. The tension may stretch out the areola and may flatten the breast a bit. With all that said, I think you may be a candidate for a small donut lift but likely keeping your areola similar in diameter to what it is now. I know that doesn’t sound ideal but that may be the realistic option. This procedure would be performed under local anesthesia in our practice. Hope all this makes sense.

Well, your areolas are large so you are going to need a strictly peri-areolar lift. If done meticulously with a locking cartwheel dermal suture of polytetrafluoroethylene (Gore-Tex), you can have a nice result. The bad result people talk about with a peri-areolar mastopexy is a stretching out of the areola and scar widening or hypertrophy. Your areola takes up too much of the width of the front of the breast to do a vertical incision without pinching it in too much at the 6 o'clock level.
The surgeon can resize your areola to a smaller diameter, if that is what you want and agree with, then outline an oval starting at the desired top of your new nipple/areola position. The lower boundary of the oval is just outside the 6 o'clock position of your current areola, assuming the distance from that point to the infra-mammary fold is about 6 cm. on stretch.
Then the large circle is carefully matched to the areola by placing sutures at each quarter of the larger diameter to every 90 degrees on the reduced areola. Then further sutures close the outer to the inner using the same halving principle. This prevents any excess tissue bunching around the circle. When done meticulously the incision usually heals with very little bunching. Any bunching usually flattens out in a couple months. When done this way, you are decreasing the risk acceptably of any stretching out of the areola.
The pocket stays the same. Just because the skin is snugged down around the implant doesn't mean the pocket is smaller.
I don't see why anyone would think that you did not need a lift at the initial operation. From your pictures, it is clear that you did.
By the way, you don't really need an areola reduction if you don't want one. It actually makes the matching of the outer to inner circle closer, since the outer circle is being brought to a larger inner one. This means less mismatch of size, less pressure outward on the incision line, and less bunching of the closure. It's just an automatic reaction when you see large areolas, to make them smaller when doing a lift. That, however, is strictly your decision to make. Some women want their areolas reduced in diameter and some do not.

Unfortunately, you did the procedures in the wrong order. You should have done the breast lift first and then you may not have needed implants. An alternative to consider is explantation and breast lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Would wait a full year to allow implants to fully drop and fluff; lift might not be necessary. 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