Asymmetry & saggy breasts needs doctors advice for going from an A cup to a C cup. What is the best procedure for me? (photos)

I am considering fat grafting or implants for breast augmentation. Do I need a lift as well with either procedure? What is my best option for me? Also, could I do a subfacial placement if I went with an implant?

Doctor Answers 11

Breast lift and implants vs fat

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Thank you for your question and posting pictures. Based on your pictures you seem to be a good candidate for a breast lift and augmentation. You may or may not be a candidate for fat grafting at the same time depending on your goal size. You need to be examined by board-certified plastic surgeon and discuss these options in person. Vectra 3-D imaging will able to simulate different sizes of implants and lifting procedures for you. You would likely need a less invasive vertical (lollipop scar) lift and implants placed under the muscle. Unless you are very athletic in terms of competitive sports, I would recommend placing implants partially under the muscle (dual plane). 

New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Breast enhancement

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Based on the photos provided I would advocate a combination breast augmentation and mastopexy (lift).
The left is required to correct your breast shape and lift your breast and nipple. An implant will increase your breast volume. A physical examination would give a better idea as to which plane is best for the implant.
Best of luck.

Breast lift and implants

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Yes, I think based upon your photos I think that a breast lift and implants would be a reasonable option.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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Asymmetry & saggy breasts needs doctors advice for going from an A cup to a C cup. What is the best procedure for me? (photos)

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Based on the photos I would suggest a breast lift together with implants. These 2 combined procedures would lift and enalrge the breasts to the cup size that you desire. I believe you would be a ery good candidate for the procedures. You should consult with a Board Certified Plastic Surgeon. Good luck!

Asymmetry and sag

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Thank you for your question and for providing the photos.  Based on the photos, I think that a combination of breast lift with implants would be necessary to give you the best results.  Your breasts have some sag, or ptosis, which would require a mastopexy, or lift, to improve.  This will allow the breasts to be lifted and the areola to be centered on the breasts. While this will result in some scars, these typically fade well over time.  Without a lift, your breasts may be larger but the shape will not be improved.

Your breasts also have some deflation or volume loss.  In order to go from an A to a C cup, implants are usually the best option.  This will give the fullness above the braline that many women wish for, but also maintain a natural look.  Fat grafts are used in some cases, but would likely require multiple stages in your breasts to achieve the size that you are hoping for.

Of course, an in person exam would be necessary for the exact recommendations.  At this time, implant sizes could be selected to meet your expectations and the specifics of the recovery and procedure explained.

Best of luck with your breasts.

Jeff Rockmore 

Lift and implant

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Thanks for the question

You have great pre-operative aesthetics and anatomy. I would suggest an implant between 270 and 300cc along with a vertical or lollipop lift, this will give you a nice shape without too much of a "done" look

Aug plus lift?

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Based on your pictures,in our practice, we would suggest an augmentation plus mastopexy due to the degree of atrophy and sagging."Lollipop" scar likely needed,periareolar lift is not powerful enough for this.I would also consider you not a great candidate for fat graft alone.

Robert Savage, MD (retired)
Wellesley Plastic Surgeon

Breast asymmetry and sagging

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Thank you for your questions. I would recommend a lift with an implant. I feel you would need a lollypop type lift. I would not recommend an implant placed above the muscle. It may correct some of your sagging but not all of it, and you look fairly thin on top, so the implant would show more and be less natural. I also believe sub muscular implants would stay softer longer and look more natural. I would also recommend performing them together as this is my routine and most surgeons as well. Look for a board certified plastic surgeon in your area who performs these regularly.

Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

Asymmetry and sagging

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Thanks for your question and photos. 

If you decide to choose a breast enlargement, I think that a lift is necessary also. The likely outcome of increased size without a lift will be the natural breast tissue draping off the implant. In many cases, the procedures will be done together.  If you are choosing a large augmentation, many surgeons would recommend doing the two procedures at separate operations.

You appear to be rather slender in the limited photos posted, so fat grafting is probably not going to be an option. 

An in person exam at a consultation will be the way to get proper answers to your questions.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Asymmetry & saggy breasts needs doctors advice for going from an A cup to a C cup. What is the best procedure for me?

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 Thank you for the question and pictures. Based on your description and photographs, I think you will benefit from breast augmentation/lifting surgery.  Although more specific advice would necessitate in person consultation, including a full communication of your goals etc., some general thoughts may be helpful to you. 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.
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, while at the same time removing some of the balloons rubber surface.  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.  
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.

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.