Am I able to get away with just implants? (Photo)
Doctor Answers 18
Am I able to get away with just implants? Breast lift necessary?
Thank you for the question and pictures.
You will receive several different pieces of advice online, just as you will during in-person consultations. In my opinion, it is clear that you WILL benefit from breast lifting surgery. I do not think that your situation is really “borderline”; in other words, you will not end up with an aesthetically pleasing results if you undergo breast augmentation surgery only.
If you were to undergo breast augmentation surgery only I think that 2 types of “results” would be predictable:
1. You will end up with “big and low” breasts and unhappy with the aesthetic outcome etc.
2. You will end up with the breast implants sitting high on your chest wall with the breast tissue lower down, again creating an aesthetically unpleasant outcome. You will find that you will continue to have breast skin sitting on top of upper abdominal wall skin, unless you lift the breasts.
For some patients the necessity of additional scars is a “dealbreaker” ; for these patients it is better to avoid breast surgery altogether.
On the other hand, many patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.
Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate; obviously, the need for additional surgery, time off work/life considerations, and additional expenses our “factors” that should be considered before undergoing the initial operation. I would say that, in most communities, anesthesia and surgery facility fees (minimally) are patient responsibility, when returning to the operating room for revisionary breast surgery.
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift.. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate. The analogy I use in my practice is that of a thinned out balloon, being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation. To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications. Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts.
Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery. Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. The attached link may also be helpful. Best wishes.
Revommending a mastopexy procedure on a dark complexioned patient is looking for scar trouble. I know we like scars. But I hope this pretty lady understand the consequences of all this free advice. Adding 150 cc to breast implants size is usually disappointing. This lady just wants bigger implants.
I will definitely recommend a breast lift. A very large breast implant will only temporarily correct the problem. He's very large implants will long-term drag your breast down to a very low position
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Breast augmentation with breast lift
Hi. Based on your pictures I would certainly recommend a breast lift in conjunction with a breast augmention via implant. This can be done as a combined procedure (with the possibility of needing a revision in the future because of the multiple variables associated with combining these surgeries), or as 2 separate surgeries. Personally, I do not like the idea of trying to avoid a lift by going with a larger implant, as I feel that leads to other problems, which can be very difficult to fix. I would recommend consulting with a board-certified plastic surgeon with good experience in this area. Good luck and take care. Dr. Howell
Breast implants without a lift
Many patients are concerned about a breast lift procedure because the scars associated with a breast lift procedure may not be desirable. But the alternative of only using an implant and overfilling the breast to attempt a lift is a poor substitute, in my opinion. The hanging lower glandular tissue will always be visible spoiling the overall shape of the breast. To get the best result from a breast implant procedure it is essential to ensure that the breast gland is centered over the implant, which in some cases requires a breast lift. Although many physicians have attempted to avoid the lift by using a larger implant, this has rarely resulted in a desirable final result. I would suggest visiting with a board certified surgeon for an in-person consultation to get a final answer to your questions.
Breast Lift with Implants
Thank you for your question and for sharing appropriate pictures. You do seem to be a good candidate for a breast lift with implants. Unfortunately implants alone will not give you the desired results. Often women who opt for breast implants alone when considering a lift, go back and have the lift later anyways because they are not satisfied. I would recommend undergoing Vectra 3D Imaging to get an idea of your post procedural results. Make sure that you are working with a board certified plastic surgeon for precise recommendations.
Will I need a lift?
Hello and thank you for your question. You should seek a consultation with a board certified plastic surgeon to have all of your questions answered, That being said, you will achieve better results with an augmentation and a breast lift. I hope this helps and good luck finding a surgeon.
To lift or not to lift
Thank you for your question and helpful photos.
Placing a larger implant in your case will definitely NOT give you the results you have pictured above. Those women probably began with an A cup or very minimal breast tissue. In other words, your situation is much different than theirs pre implants. You need a lift. Otherwise, your results will be exactly what you have now, but much larger. Bigger saggy breasts is not a good look. Breast implants do not and cannot lift breasts. Please do your homework and search for results in the breast augmentation revision forum on this site. You actually have enough breast tissue to have a lift only -without implants - or the vertical incision that conventional lifts require. The attached video is of a woman's results who required a lift but she did not want the complications/maintenance associated with implants nor the ugly vertical scar. You will need to visit my video gallery to see her before video. I hope this helps.
Am I able to get away with just implants?
If you are trying to avoid the scar of a breast lift, you could always just get the implants first and let them settle. If after three months you are not satisfied with your appearance, then you could consider a mastopexy. Good luck!
Breast lift with implant
Hello and thank you for your question. The
best advice you can receive is from an in-person consultation. With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a wise pattern 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 wise pattern lift with an implant can
result in a very nice shape if good technique is used. The
size 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.
Harvard-trained plastic surgeon
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.