I am very unhappy with my breasts at 47 years of age and wish to know what to do about them? (photo)

Hi DaisyMae71,

Determining whether you need simply a breast implant versus a breast lift or both 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 breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift.

These two surgeries can be done at the same time and this may be optimal as the risks can be minimized. 

My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift).

Most importantly, it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, it is actually breast tissue that is being brought together to support the breast and hence improves longevity.

In addition, upper pole fullness is achieved with appropriate implant selection but more importantly, submuscular placement, and precise pocket dissection. The submuscular placement allows the muscle to cover the top part of the implant which allows the upper pole to appear fuller. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Most of patient in your age and with such a presentation know that they need a lift but they do not want a scar, in particular a vertical, lollypop type. However, there is no good result without such a surgery. You need skin tightening to lift that breast and place nipple/areola on top of the breast mount. In your case, as with almost all women except those few with a very hard breast tissue, breast lift alone is not option because in few months you will see that upper pole of breast is becoming flat due to descent of tissue due to  gravity. For that reason, a small implant placed on top or underneath the muscle would improve durability of breast lift result. With breast lift patient will lose 1/2-1 full cup size which can be compensated with small implant to keep you within your original bra size. Once patient is satisfied with shape and size of breasts scar becomes no issue. Good luck.

You appear to be a better candidate for a lift (with or without implants) than fat grafting. Scars should heal nicely after a mastopexy on you.  Although it is hard to guarantee scar resuts, it could be that looking at postop photos from your plastic surgeon of choice would make you feel more comfortable.  Scar management postop should also be a topic of discussion.  Best of luck!

From your photographs, to get the most aesthetic result without adding any more volume, a lollipop or anchor pattern breast lift would best serve you. It is completely your decision whether you prefer better nipple position and a younger looking breast, or scars. It is a trade-off that you have to balance.

Thank you for your question and based on your pictures you seem to be a good candidate for a breast lift with a small implant for upper fullness to achieve your goal, always see a board certified PS.

Thank you for your question. Based on your photo it appears that you would definitely benefit from a breast lift, which reduces the skin envelope while reshaping the breast tissue into a more youthful and perky shape.  Sometimes implants can also be added for more volume, but this increases the complexity of the operation and recovery and so must be done by someone with a lot of experience.  All breast lifts require external incisions – while some scars will remain, breast lift patients find that the improved breast shape is well worth the tradeoff. A breast lift can rejuvenate your figure with a breast profile that is youthful and uplifted.

Thank you for your question and helpful photo.
I understand your reluctance in undergoing a breast lift. The conventional vertical scar techniques do not provide adequate lift nor do they last very long. They rely solely on the skin envelope to keep the breasts in place. Current breast lifting technology has improved remarkably by eliminating the vertical scar component entirely and by designing an internal suspension system that creates upper pole fullness without needing an implant (extra cost, risks and complications). I hope this helps.
Best wishes and kind regards,
Dr. H

Hello dear!!
Thanks you for your question. It is my pleasure to help you with your concerns.
You can be your own best version, and you can definitely achieve amazing results with plastic surgery in order to improve your breasts. For you, I recommend an anchor incision breast lift with areola reduction, for perkier, youthful breasts. The scars should fade with time.
I suggest you to make an appointment with a board certified plastic surgeon for a good evaluation and to talk about your goals.
I hope this is helpful.  Good luck :)

Do not be nervous about the scar potential. Yes, it must be considered, but meet with your plastic surgeon to review photos of their before and after mastopexy patients. It is my opinion your will be able to achieve a fantastic result with the help of a good surgeon.

If you want your breast fuller and are happy with the shape of them, then an implant will be fine. Keep in mind an implant will only "fill our breast up" it will not "lift them up". They will look just like they do now, they are just bigger and fuller with an implant only. If you feel this will meet your goals, then an augmentation should be fine. If you are unhappy with the position of your breast and feel they are too low, then an implant will likely not satisfy you and you will want to consider the lift. A lift will "lift them up" and put them in a higher position, change the size of the areola and "lift" them off of your chest. Often times both of these procedures are combined to achieve an optimal result. By lifting them and adding volume, the breast will not only sit higher on your chest but will also have the nice fullness from the implant. In your case a breast lift with augmentation is likely going to give you the best result.  Dr Scott Ennis