5’4”, 128 lbs, fit, age 38, small breasts - am I a complicated case? (Photos)

Question

5’4” 128 lbs, fit, age 38, post pregnancy and nursing. Disproportionate areola -especially soft - and since teenage years they always hung “low” and my breast only looked somewhat normal when my nipples were hard. My breast tissue only projects one inch or so (not counting projection of actual nipple). Is this a complex case where inserting a (shaped?) small or moderate implant won’t get me a nice full, sloped look? What would you recommend?

Finny George, MD · Answer

Hi, thank you for sharing your question. You are a great candidate for breast augmentation and I don’t think that you should feel that you are a complicated case. Every patient and every surgery has its nuances which should be addressed to tailor the surgery to each patient’s specific goals. Once you have had an opportunity to see a board certified plastic surgeon in person, you will feel more confident about what you can achieve. The exact sizing and specifics of the implants are determined together with your surgeon.

Donald R. Revis Jr, MD · Answer

Good morning,
You are an excellent candidate for a submuscular augmentation with saline or silicone implants, depending on your preference. We would determine the exact size and profile when I measure your chest, we review photos together, and you have an opportunity to try on the implant sizers here in the office! I would also consider a donut mastopexy because your nipples are a little low on your breasts, and they do not sit at quite the same level. A donut mastopexy would improve your symmetry and give you a better result!

Gary M. Horndeski, MD · Answer

The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Scott W. Vann, MD, FACS · Answer

Your breasts are small but more deflated than sagging. I think if you have a simple breast augmentation with a round smooth implant and submuscular placement, you would have a great result with a normal slope to the breast to give you a natural look. I do not recommend or use shaped implants since they are textured and there is several downsides to texture. Discuss all options with your surgeon. Good luck.

Daniel Barrett, MD · Answer

Dear Maybe_yes,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert M. Tornambe, MD · Answer

I appreciate your concerns and it appears from the photos that pregnancy and nursing has left your breasts deflated with pseudo ptosis. However things are not as bad as you think!
Breast augmentation with placement of moderate plus round smooth silicone implants under the muscle should be an excellent option for you to rejuvenate your breasts and provide a perky and attractive shape. Come see me or another board-certified surgeon to explore the best options for you. Good luck!

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. 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 and they choose what looks right for them. 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. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Irena Karanetz, MD · Answer

Hello,
Thank you for the question and the photos. 
Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions of your chest wall. I also utilize Vectra 3D planning to further help with implant selection. Based on your photos, 350-400cc range size implant will likely give you a nice fuller cleavage that you desire.
Typically, silicone breast implants are used because they offer more natural feel than saline (salt water filled) implants.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon in order to discuss your goals and concerns for the best cosmetic results. 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.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Garrett A. Wirth, MD, MS, FACS · Answer

All breast augmentation cases present unique challenges.  I recommend you work with a Board Certified Plastic Surgeon for a full consultation and measurements, etc. to match the implants with your goals.  You should be able to achieve very nice shape and volume based on your descriptions and pictures.

Camille Cash, MD · Answer

From your photos and description your situation seems within the vast realm of "normal" that board certified plastic surgeons treat regularly.  The first step is to schedule consultations with a few surgeons to discuss your goals for surgery and learn more about the procedure.  During this important meeting you will also discuss potential implant styles and sizes.