I am a 36DD. I need a breast lift with Implants. How do I get chest fullness without going too big?

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  It would be helpful to view pictures of your breasts.  The size, profile, and shape 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.  

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

Unfortunately, you have not provided photographs.  However, since you are a 36 DD, you have enough volume.  You would benefit from a lift more than augmentation.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  Implants are not lifetime devices.  Best Wishes,Gary Horndeski, M.D.

Dear rfargo1994,
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 more full. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side. 
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 sizer 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

If you are a DD, you may not want to add more volume to have a larger breast and more risk of sag. You could consider a small breast reduction and an implant placed behind the muscle for better upper breast fullness.

Hey there rfargo1994 in OK! Thank you for submitting your question.  I like this question.  I think it is broad in terms of the suggestions and recommendation of PS's. To obtain an adequate upper pole fullness and size without going too big, experience matters for the PS.  When doing a breast lift with augmentation, the patient ideally has two options. These options include placement of an implant or fat grafting. They are both predictable and long lasting.  However, fat grafting does not give as much shape that an implant would provide in the upper pole of the breast.  With that, it depends on the size and shape the patient desires.  If you are wanting to increase in volume but eliminate the saggy breast tissue, the surgeon will weigh the amount of breast tissue that was removed during the lifting phase and replace that amount with the same in an implant or with fat.  Lifting the breasts will bring the nipple to the mid line and in the center of the new breast mound. Skin quality is also taken into consideration and if the implants are placed behind or in front of the pec muscle.  I like to place mine behind.  I feel this gives better aesthetics to the breasts for a longer duration. Lastly, you can stay a DD or downside and still end up with perky, full, pretty breasts.  The end size should be up to you.  I hope this information helps and good luck. 

Thank you for the question. You may wish to post photographs, frontal and side views with your arms by your side, for more precise thoughts.  Having said the above,  based on your description of breast size and goals only,  it sounds like that you may benefit from breast reduction/augmentation surgery.  During this operation, some breast tissue is removed and breast implants are utilized for volume/fullness. Sometimes, the operation can safely be performed in a single stage;  sometimes, patients are off undergoing breast reduction surgery first followed by a second stage breast augmentation procedure.

  In other words, best to individualize every patient's treatment plan  based on her unique circumstances,  anatomy, and goals.   During this decision-making, safety consideration and avoidance of complications, should be paramount.

  Ultimately, which operation you should undergo will depend mainly on your physical examination and personal goals. If I were seeing you in consultation, I would ask that you communicate these goals in terms of goal photographs and/or computer imaging.  This type of careful communication, preferably in front of a full-length mirror, is key. Avoid the use of cup sizes as a reference point; this can be a source of confusion and miscommunication.

 My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as discussed above.  Avoid potentially confusing terminology such as "chest fullness" or "too big", which may be interpreted differently by different people.  In our practice, preop communication is best carried out with the help of goal photographs and computer imaging. Working together you will come up with a good plan to achieve your goals.  Best wishes.