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!