I hate my breasts. They are saggy, large uneven areolas, and my nipples lay completely flat unless cold or stimulated (Photo)

Dear Patient: thanks for your questions and photos. You're a great candidate for a Breast Augmentation with a lift around the areola.  An in person consultation with a Board Certified Plastic Surgeon would be needed to determine the size and style of implant that would match your desired outcome.  

From your images, you will benefit from breast implants and a breast lift.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon 

it appears you are borderline as far as whether a lift would be required.  If I were to perform a lift in your case it would be the lollipop type lift with implants around 350 cc's.  The decision to get a lift will depend on how much the sagging bothers you and your willingness to have some scars as well.

Hello, Thank you for your question and posting your photos.
Based on your pictures, you need to have a breast lift and implants. There will be an incision around your areola, so the size of your areola can be reduced and they would look natural. It won't change the shape or size of your nipple though.
Kind regards,
Guray

Thank you for reaching out and posting pictures! There are a few important factors that go into whether or not I recommend a lift to patients. Here are a few things that determine if I am going to suggest a lift. 1) Is the measurement from your sternal notch (that little depression above your breast bone) to the nipple longer than 20cm? (8 inches). 2) Does your nipple point downwards? 3) Is your nipple below the crease under your breast? Besides the measurements, the end result you are looking for plays a huge factor! It is not always easily determined by photos, but  best determined with an in person consultation. Be sure to visit a few experienced Board Certified Surgeons! I hope this information helps! Best of Luck! Dr. Kachenmeister

Thanks for the question.First, please don't be so hard on yourself. Many women have changes with childbearing and/or breastfeeding and these are due to having provided the greatest service that exists - caring for children.We plastic surgeons are here to help. Breast lifting with implants appears to be the most appropriate option to correct for sagging and deflation, add volume, and address areolar shaping and asymmetry. Surgical simulation software, available in our office and the offices of many top board-certified plastic surgeons, can help show the potential effects of implants, lifting techniques, etc. The type of lift, including incision choice, is dependent on physical exam findings in the office. Happy to help!

Thanks for your photos and I do agree with the others that you are too critical of yourself.  During a face to face consultation, a plastic surgeon will be able to discuss with you the options that exist regarding breast implants and their size (based on your goals) and various forms of uplift.  You may be a candidate for any of the types of lifts available including Benelli (periareolar), J-mastopexy, vertical mastopexy (lollipop) or full mastopexy (anchor incision) depending on how much or little skin removal is necessary and how droopy and empty your breasts are.  My general advice is to avoid going too large with implants that will thin and stretch your breast tissue and skin over time and seek a natural balance with good nipple position.  Be certain to visit an ABPS Bd Certified plastic surgeon and review before and after photos until you are satisfied with your selection of treating surgeon.  Watch the video above for additional info and enjoy your results!
Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Member, ASAPS, ASPS

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Dear Ms. Moonovermypammy,
Thank you for your story, questions and photos.  
Nothing substitutes for a personal evaluation and a face to face discussion of your options.
Unfortunately without a examination and measurements  I can advise you in general terms, however I hope you will find them helpful.
Based solely on your photos you most likely will need a mastopexy (lift) and enhancement with a breast implant.
The look you want is based on a carefull understanding of your desires and customized surgical technique, selection of implant, placement and lift.
My response/recommendations:1) the reason your breast sags is that the "skin covering" is proportional larger than the breast tissue.
2) the majority of your breast tissue is below where the breast mound should anatomically be located.
3)if you refill the volume only(breast implant)... the nipple areolar complex (NAC) will tend to rotate over the top of the implant like a waterfall resulting in a full breast mound but unfortunately a downward rotation and location of the NAC.
4)the only method known to create a aesthestically acceptable breast will require trading incisions/scars on the breast for a pleasing contour and relocating the NAC.
5)depending on your desires (shape and size) the scar may vary from:A) just around the nipple (doughnut)B) to a added vertical incision (lollipop)C) to include a horizontal incsion in the breast crease (anchor).
6)while breast incisions/scars are required....there are ways to modulate/improve the appearance of the scarring process.
7) you could always start with a augmentation only and if you like the appearance= greatif you want a more sculpted breast with a higher NAC then you could undergo a lift (often just under local anesthesia).
8) select 3 nude model photos of breast you consider your goal breasts and bring with you to your consultation.
9) your areolar can be reduced to the size you desire.
10) nipple projection can be enhanced with fat injection Please make a appt. with several experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally a members  of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
My best wishes,
R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

You are too hard on yourself-your breasts lok much better than many. A combination breast lift with implants is likely your best option. The areolae can be made smaller by yhe lift. Read below: