Volume loss - Lift or Implant? Opinion on Preserve method with Motiva? (Photos)

Question

Dear Doctors I lost volume post lactation and weight loss. I do not mind mild sagging . Could I do with little implant only or would I benefit better from the lift? If lift then would a vertifcal scar be necessary? If implant - could I use the new Preserve method? What do you think of this method? thank you for all the recommendations.

Mert Demirel, MD · Answer

If you do not mind mild sagging and your main concern is lost volume, a small implant may be reasonable. An implant can restore fullness, especially in the upper breast, but it will not truly lift the nipple or tighten loose skin.
From the photos and description, you may be in the borderline area between implant-only and lift with implant. If the nipple sits above the breast fold and the skin is not too loose, implant-only can sometimes work. If the nipple is at or below the fold, or the lower breast skin is stretched, a lift will usually give a better shape.
A vertical scar is often needed when the breast needs real reshaping or nipple elevation. A periareolar scar alone gives limited lift and can flatten or stretch the areola if too much is attempted.
The “Preserve” method with Motiva is a branded technique and may be suitable for selected patients, but the name of the method is less important than the fundamentals: implant size, pocket control, tissue coverage, nipple position, and whether the skin envelope needs tightening.
My advice would be to ask your surgeon one key question: will my breast tissue sit nicely on the implant, or will it hang off the implant over time? If the answer is uncertain, a lift may be more predictable. If you accept mild sagging and want a natural, modest result, a small implant-only approach may be reasonable with realistic expectations.

John L. Burns Jr., MD · Answer

Based on the photos you submitted the most important procedure would be a breast lift and you might also want to place a small implant for upper pole volume, cleavage, and roundness.  While Preserve can be used in conjunction with a breast lift, in my opinion there is not much benefit to using Preserve as the advantages with anesthesia and recovery are basically negated with the need for a breast lift.  In my opinion, Preserve is best for small volume primary breast augmentation

Serdar Bora Bayraktaroglu, MD · Answer

A breast lift is strongly recommended over an implant alone. Because lactation and weight loss cause volume loss and skin laxity, an implant by itself only stretches the skin further without correcting sagging or low nipples. A lift is necessary to remove excess skin and reposition the nipple. Regarding scars, a vertical scar is typically required to achieve a proper, lasting lift and shape. While the Preservé method is an innovative technique for gentle implant placement, it is an augmentation tool and cannot fix skin laxity or sagging on its own.

Joel Patrick Maier, MD · Answer

I think you would benefit from a vertical mastopexy due to the excess skin in the lower aspect of the breast (pseudoptosis). Your nipple position is only slightly low, but the lower aspect of the breast would benefit from skin removal to improve shape and tightness. I hope this helps. Thank you!

Semih Yildiz, MD, FEBOPRAS · Answer

An implant can restore some upper fullness, but it will not reliably tighten loose skin or raise the nipple. I reviewed the photos; they show post-lactation volume loss with mild-to-moderate looseness and some lower-pole descent, so the choice depends on your nipple position relative to the breast fold and how much lift you want.
If the nipple sits acceptably and you only want modest volume restoration, a small implant may be reasonable. If you want the breast envelope tightened, the nipple/areola lifted, and a firmer shape, a lift is usually more predictable, and a vertical scar is often needed for meaningful reshaping. Motiva Preserve may be useful for selected augmentation cases, but it does not replace a lift when skin excess or ptosis is the main issue.

Daniel Barrett, MD · Answer

Dear Neat64678,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Laura Roider, MD · Answer

@Neat64678 Thank you for including photos with your question. It helps to provide accurate recommendations. Like many women, you've probably lost a significant volume following breast feeding. 
Based on your photos, I would recommend an anchor mastopexy (breast lift) to address the nipple position and excess skin you have, this can be combined with a augmentation (either traditional or Preservé). The anchor mastopexy involves a scar that goes around the areola, down the inferior pole of the breast, and along the inferior breast crease. 
As for Traditional vs Preservé: This depends on your goals. You would likely be a candidate for both but there is a limit to the volume implant that can be placed with Preservé (315cc). The main difference is where the implant is place (above or below the muscle) and how the implant pocket is created. The benefit of Preservé is that the supportive breast ligaments are maintained and there is decreased risk of inferior implant malposition. 
I recommend you discuss your goals with your plastic surgeon and evaluate all options. Hope this helps.

Kadir Berat Oyur, MD · Answer

Hi and thank you for your question. Based on your photos, you are suitable for breast implants combined with a lift to restore volume and address any sagging. A consultation would help determine the best size and approach for a natural result. I hope this helps.

Wayne I. Yamahata, MD · Answer

The procedure of choice would depend on your goals. Implants provide volume but very little lift. if your goals are only volume then implants alone will suffice. If the sagging bothers you, and you would prefer that the position of the breasts is raised then a lift would be necessary.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. You have a grade 2 ptosis. Adding an implant would slightly increase your ptosis due to the increased weight of the implant. Your best breast shape, contour and position would be achieved from a breast lift.  An anchor incision, which includes a vertical incision,  would be needed to remove the excess skin from your breast.  Once the excess skin is removed, all of your breast tissue can be enclosed/sutured into the reduced skin envelope.  Keeping the same volume of breast tissue in a smaller skin envelope will full out/plump up that skin envelope and make your breast look slightly larger.  Avoiding a breast implant decreases your cost, and the likelihood that you would require another operation in the future to deal with any implant issues.  The key here is, if you’re happy with the volume of your breast tissue, but are unhappy with the position of your breast, then a breast lift is your answer. If you need additional volume, then an implant would be required.  The preservation method is a supposedly gentler way to do a sub fascial breast augmentation by allowing an inflatable expander to dissect the pocket that your permanent implant will go into, as opposed to creating the pocket with a cautery.  I have seen no scientific studies that indicate the preservation method gives you any faster recovery or better result than a standard sub facial breast augmentation performed with traditional methods.   Best wishes.

Volume loss - Lift or Implant? Opinion on Preserve method with Motiva? (Photos)

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