Opinion on Dfferent Consultations, I Would Like to Another Opinion, Do I Need A Lift? (photo)

I had two consultations today, I am 55 140. I want large dd round silicone implants plced under the muscle high and wide profile done through a insision in my breast fold. I used to be a d but due to children I am a deflated small c. One doctor completly agreed with what I am looking for, I dont want lift scars and feel that I can always have a lift down the road,I want to look my best and I also raelly like the done look and knwo the sizewill balnce me out, another doct feels a lift is necessar

Doctor Answers 19

You will likely need a breast lift however breast augmentation first with lift 6 months later may be your best option

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Thank you for your photographs and question. I agree with most other doctors that a breast lift will most likely be required for you to achieve the look that you show in the ideal photograph.

Since you are concerned about the scarring associated with a breast lift 1 solution is to have the breast augmentation first, and wait 6 months to see if you are satisfied with your results. You can always have a breast lift as a second procedure and many believe a better result is possible after your breast implants have settled.

However you must have a clear understanding with your surgeon that a breast lift is under consideration and you should not be upset at 6 months that a breast augmentation alone does not give you the appearance in the ideal photograph.

You Are A Great Candidate For A Dual Plane Mastopexy With Subpectoral High Profile Silicone Implants

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The position of your nipple vis-a-vis your inframammary fold appears to be appropriate for a dual plane mastopexy.  First the implant is placed below the muscle, then there is a release of tissue on top the muscle which allows the nipple areolar complex to rotate upward.  Post operatively, an ace wrap worn for about 10 days keeps the implant from riding too high, and large piece of sticky plastic called Opsite can pull your nipple areolar complex upward after the dual plane is accomplished.  Many doctors call this the scarless mastopexy.  It is a great technique.

You need a consultation with a Board Certified plastic surgeon who has a lot of experience in dual plane mastopexies with implants.

You need a lift!

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Please don't be fooled! Do your research! I'm not sure if you can see pictures of women who have had implants alone (no lift) with your dimensions or similar. It just doesn't work and it doesn't look pretty! If you are afraid of the vertical scar, then it may behoove you to research the Ultimate Breast Lift. It is a new technique that achieves upper pole fullness without the need for an implant and without a vertical scar. A patient's own tissue is re-arranged using engineering principles to achieve a more permanent lift without all the visible scars. If, however, you are set in increasing your volume, then I would suggest a small subpectoral implant and utilizing a variant form of the UBL to pull your existing 'low-lying' breast tissue directly above the implant. This will achieve the roundness/fullness you are searching for with a scar around the areola only. It's worth looking into.

Dr. H

Breast Augmentation with or without Breast Lift

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Hello dsan19,

Look at what's different between your photos and the photo of the person you want to look like.  Do you see that there is no visible breast skin below your areola?  In fact, we can't even see the lower edge of your areola because of where your nipple areolar complex is located on your ptotic breast (sagging breast ).  BTW, you have grade III ptosis, not grade I.  Look at the photo of your ideal breast appearance.  You can see quite a lot of breast skin below the lower edge of the areolas (actually more on the left than right).  This means her nipple areolar complexes are in a desirable position on the breast mound. 

It may be true that you have many options available to you, there is only one that will even remotely achieve the desired appearance: a breast lift in conjunction with a breast augmentation.  Don't be fooled, there is no breast implant large enough, or high profiled enough, or positioned over your muscle, to get your current nipple areolar complex to magically rotate upward into the desired location on your breast mound without actually doing a breast lift.

Best of luck!

Lift vs Augmentation alone

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The decision to have a breastlift is reached between the surgeon and the patient.  There are definitely women who do not need a lift and women who definitely do need a lift.  There is a large group of women, however, who may look better with a breast lift, but they will look pretty good with a breast augmentation alone also.  Those women need to choose how much improvement they want or need and they need to decide on the trade off of more visible scarring with the lift.

Judging by your photos, I think you are a good candidate for a breast augmentation alone.  You can make the judgement after the breast augmentation about the lift but I would bet that you will be very happy with the breast augmentation alone.  The breastlift can always be done in the future, but if you find that you do not like the breastlift scars, they cannot be undone.

Thank you for your question and best of luck.

To lift or not to lift, that is the question.

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Answer:  It really depends on how badly you want to be high and perky versus the price you would pay to have a scar that goes all the way around the nipple.  The implants themselves won't lift you and your areola will likely widen from the stretch of the implants. If you like the high look, then you will likely be unhappy if your implants fall into a sagging breast skin envelop. It is also hard to say for sure from the pictures you included. To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

Breast lift and augmentation

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As a general rule of thumb if your nipples are at or above the breast crease, then most individuals will do fine with just the breast augmentation.  If, howevwer, the nipples sit below the inframammary crease, then a breast lift with the augment would generally be the best option.  I think that you are correct in assuming that an augment alone would give you the results you seek and you can always come back later and do the lift if you are unhappy.   

Do you need a lift? Only if you insist on the results you are desiring!

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This is a very common question and certainly Plastic Surgeons what you to be happy and to only add scars if absolutely necessary.

An augmentation alone will not produce an ideal breast shape. The nipple will remain lower on the breast even with larger than recommended implants. Your breast skin envelope has stretched in addition to you losing some of your volume. Adding more volume will make your breast larger, give the appearance of lifting your breast by partially filling in the upper pole and further filling out the bottom. The net effect will rotate the nipple upward but your breast will still fall over the crease and remain at the same height once swelling subsides. To get more roundness and fullness to the breast you will need a larger implant. Although this will create some of your goals in the short term, you risk rapidly stretching your breast tissues, compressing your native breast and all of this results in more sag and loss of upper pole fullness. If you choose to gamble with this approach and need a lift in the next few years then lifting a heavy breast does not work well. Most Plastic Surgeons would then insist on you choosing a smaller implant at the time of a mastopexy.

Sometimes you can not have everything that you want. If you can accept a larger, fuller breast with the nipple still a bit low, some overhang over the breast crease and the long term plan of a smaller implant with a breast lift - then go ahead with an augmentation. Otherwise modify your expectations and goals, choose a smaller implant with a lift and enjoy your rejuvenated shape and figure.

Dr. Mosher



To lift or not

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You certainly can just put breast implants in and decide later to have a small areola lift or a more involved procedure.  Normally with breasts that look like yours, I use a circumareola approach and raise the areola while doing the augmentation, but this certainly coudl be staged if that is what you want.

Is breast lift needed?

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You can get a very attractive result with augmentation alone.  However, it will not likely be the result you are looking to achieve.  To get a breast shape like the one in you example, a lift will need to be done.

You are correct that a breast lift can be done at a later date if you do not like the result with augmantation alone.


Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon

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.