Age 33, 130lb, 5'5", 33B - Mastopexy and submuscular implants or subglandular implants without lift? (photos)

Question

I did a consult today with a surgeon in my area and was presented with a couple options. I am 33 years old, 130lbs, 5ft 5inches and am currently a 33B bra size. I have grade 1 sag and extra skin from breastfeeding. The surgeon said i am borderline needing a lift. I can choose to do subglandular to avoid the lift (im concerned about longevity and sag) or submuscular and mastoplexy (i dont what the extra scars). Looking for advice

William Andrade, MD · Answer

Thank you for your question.   Your concern about scars is understandable and a shared by many patients considering cosmetic breast surgery.  However, breast implants alone will only fill out the existing breast tissue, not lift the nipples to a higher position.  As your surgeon already pointed out, each option involves a compromise and there are different advantages/disadvantages.  If a person has loose breast tissue they might need larger implants to fill the existing tissue and provide fullness, but over time these heavy implants could drop/sag even more.  On the other hand, if you are having implants plus a lift, you could choose smaller implants then reshape the overlying tissue.  This does not guarantee the breasts will never change or sag, but the nipple position will be improved and result may be longer-lasting.  If find it helpful to explain the relative risks, costs and recovery time, then show patients photos of each result.  After having a thorough consultation, I find that most patients have an easier time deciding which procedure is best for them.

Jonathan Landon, MD · Answer

Hello and thank you for your question! There are pros and cons to the utilization of either plane. A subglandular placement provides good projection and shape, and helps avoid distortion in active patients; however a subglandular placement also tends to have higher rates of contracture, carries the possibility of the edge of the implant being palpable, and can interfere with mammography. A submuscular placement provides lower contracture rates, thick soft tissue coverage of the implant, and better preservation of nipple sensation; however a submuscular placement can also come with potential animation deformity with pectoralis contraction. Hope this helps!

Daniel Barrett, MD · Answer

Dear Fabfive7,
determining whether you need simply a breast augmentation versus a breast lift 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 a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

At size 33, each 100 cc of implant corresponds to 1 cup size change. Adding submuscular implants would lead to a poor outcome. Your breasts are low on the chest wall and the only thing holding up the breasts will be the skin envelope and the added weight of the implants will cause the breasts to descend even further. 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 (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Carlos Marciales, MD · Answer

Hello, in your case you need subglandular implants, and lollypop lift, your areola is not very low, but the lower pole of your breast hangs a lot

John LoMonaco, MD, FACS · Answer

If you do not mind gaining a full cup size, or more, then a higher profile implant placed using the dual-plane technique and dual-plane location may give you an acceptable result.

With a larger implant, the bottom of your breast WILL move lower towards your belly button.

If you do not desire the size increase (many of my athletic patients do not for example) or want  a modest size increase, a lift would probably be advisable.

And remember, of course, that it was a heavy, full breast that caused you to sag in the first place. A heavy implant will also stretch your skin over time.

Ronald J. Edelson, MD · Answer

It is borderline as to whether to get a lift. If you do get a lift I suggest the lollipop lift. Avoid the donut or crescent lifts. They don’t work very sell

Scott W. Vann, MD, FACS · Answer

Your nipples are slightly low but above your breast fold.  I do not think you need a breast lift. You could add one in future if you have sagging then. Avoid scar and cost for now. A Dual plane augmentation would give you all the advantages  and less complications of a submuscular augmentation. It would also fill out your lower pole enough to centralize your nipples. All with less coast and minimal scar. Discuss with your surgeon. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Ultimately the need for a lift will depend on what end result you are trying to achieve.  In most cases an implant with a lift will provide you the best shape and duration of results, but an implant alone may be sufficient if you'd like a more bottom heavy appearance to your breasts. I would recommend seeking out additional in-person consultations to discuss thoroughly your end results.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA