Which procedure would keep me at the same size while helping me achieve a fuller, perkier look? (photos)

Lift will not make you perkier. Fat transfer is unpredictable and will make you larger. Implants will make you larger but will achieve the perkiness. Laser will do nothing

Thank you for the inquiry! You have options to get the perky look you are looking for. We would love to sit down with you to discuss your concerns. Schedule a consult with a Board-Certified Plastic Surgeon to help you reach your goals.

Dear buglesalmoncat,
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

You may be a candidate for breast augmentation, there are many sizes and considerations. When picking the size of your implant, the implant must fit your body type. We will take measurements to ensure the most natural-appearing results that fit your body and achieve your aesthetic goals.
Healthy women desiring larger breasts with more cleavage are good candidates for breast augmentation. If you are getting breast augmentation with breast implants, the implant will be placed behind the chest muscle in most cases. There are a few exceptions where the breast implant is placed over the chest muscle due to the activity level you may enjoy.
At NorCal Plastic Surgery, we use gummy bear implants, which are smooth, round implants that will enhance the appearance of your natural breast, safely. They are among the safest and most commonly used implants for breast augmentation. During your initial consultation, we will determine implant placement and incision type.
Breast augmentation can also be achieved with breast fat grafting, which uses liposuction to collect the fat and then small cannulae to graft the fat into the breasts. Many women also combine breast augmentation with a breast lift, which can help improve breast sagging.

Thank you for your question. Since you mentioned weight loss, it’s possible you may not have enough donor fat to rely on fat transfer alone for noticeable fullness. Also, your nipple position appears to be a bit high, so a breast lift may not be necessary. The best option would be a moderate-sized silicone implant to have the desired fuller, perkier look without significantly increasing your size. Silicone implants are natural and provide a softer look, which will suit your desire to avoid looking too large. They can fill out the upper pole (top portion) of your breasts, giving you the perkiness you're aiming for. If needed, you might benefit from a small additional lift with minimal incisions to tighten the breast tissue around the implant.

It sounds like you’ve been through quite a journey with your breast surgeries and are now seeking a solution that enhances perkiness and fullness without increasing size. You also want to address scarring, especially the scar bulge under your left breast. Given your goals and the options you’ve mentioned, let’s explore both surgical and less invasive possibilities.

Surgical Options:
Breast Lift Revision (Mastopexy):

Since you’re dealing with sagging and loss of perkiness after weight loss, a revision lift might be the most straightforward solution to reshape your breasts and reposition the nipples. The good news is that, since you don’t want to go larger, the focus can be on improving the contour rather than adding volume.
Scarring: A skilled surgeon may be able to revise or minimize the existing scars, including addressing the scar bulge under your left breast. They could also work with techniques to help reduce future scarring, such as tension-reducing sutures or scar management post-surgery (like silicone sheets or creams).
Small Implants or Fat Transfer:

Small Implants: If you want just a little more fullness, a smaller, moderate-profile silicone implant could add volume while maintaining a natural size. With minimal added volume, this would provide a subtle enhancement and support perkiness.
Fat Transfer: This option could be appealing if you’re aiming for fullness without using implants. Fat is harvested from other areas of your body (like your abdomen or thighs) and injected into your breasts to create a modest increase in volume and fill out areas that have deflated. However, fat transfer has limitations on how much volume can be added, and it may not last as long as implants, as some fat is reabsorbed by the body over time.
Combining Lift with Fat Transfer:

This hybrid approach could give you the best of both worlds—improving sagging and perkiness with a lift, and adding natural-looking fullness with fat transfer, without the need for implants. The fat can also be used to fill out areas around the scars or stretch marks, giving a smoother contour.
Less Invasive Options:
Laser Treatments (For Skin Tightening and Stretch Marks):

Laser Therapy: Non-surgical lasers like fractional CO2 or erbium lasers can improve skin texture, reduce stretch marks, and tighten loose skin. While these won’t lift the breasts dramatically, they can make the skin appear firmer and more youthful.
Scarring: Some lasers are specifically designed to treat scars by resurfacing the skin and reducing their appearance. This could help minimize the scar bulge under your left breast.
Radiofrequency or Ultrasound Skin Tightening:

Treatments like Thermage (radiofrequency) or Ultherapy (ultrasound) use heat energy to tighten skin by stimulating collagen production. These procedures are less invasive and can help improve mild sagging, though they aren’t a replacement for surgery if the sagging is more significant.
Microneedling:

Microneedling can be combined with radiofrequency or used on its own to improve skin texture, reduce the appearance of stretch marks, and enhance collagen production. It’s a minimally invasive option to help with skin elasticity but won’t provide the same lift or fullness as surgery.
What to Expect:
Given that you’re looking for perkiness with some fullness but not larger size, you may find that a combination of a revision lift with either fat transfer or a very small implant could meet your goals. These options would provide long-lasting results while addressing sagging and improving fullness without increasing your breast size too much.

Addressing Scarring:
Scar Revision: During a revision lift or implant surgery, your surgeon can address the scar bulge and possibly reduce the appearance of existing scars. Pairing this with post-op scar treatments like silicone sheets or laser therapy may help.
Less Invasive Scar Treatments: If you want to explore non-surgical methods for your existing scars, you could try laser resurfacing, microneedling, or steroid injections to flatten and lighten them.
Next Steps:
Consult with a Plastic Surgeon: It’s a good idea to discuss all these options with a board-certified plastic surgeon who can evaluate your current breast tissue, skin quality, and scarring. They can recommend a tailored approach based on your anatomy and goals.
Consider Your Priorities: Whether it’s minimizing scarring, enhancing fullness naturally, or avoiding more extensive surgery, clarify which outcomes matter most to you.

Thanks for your question! In order to have more "fullness", you'll have to be okay with being a little bit bigger. A low profile or low plus profile can add fullness without making you too much bigger. I would suggest finding a surgeon in your area that specializes in breast surgery. Good luck!

Hello and thank you for your question!
In your case, you do not need any further lifting as your nipple position is already high. This may need to be addressed by removing a horizontal wedge of skin and tissue along your existing scar/inframammary fold. Implants would be the "easiest" way to give your breasts rounder, fuller look. Fat transfer is also an option but you don't appear to have ample donor site, so the volume/amount of fat grafted and therefore the ultimate amount that 'takes' or sticks around will be overall low, compared to an implant. The "scar bulge" on the medial breast you are referring to is called a "dog ear" and would need scar revision/direct excision to address. Ultimately, an in person consultation with a board certified plastic surgeon would be the next best step to guide you on your journey!

Your nipples are located well above your breast fold, making a lift unnecessary. Implants alone may be sufficient to give you a perkier, fuller contour. A smaller implant can be selected to minimize the size increase since you’ve mentioned that you don’t want to be larger.

Hello,

Thank you for the question and the photos.

There are few way to add volume to the breasts which may include placed breast implants again or performing fat transfer to the breasts.

In addition, scar revision procedure can be performed to address your concerns.

Fat transfer to the breasts procedure is also known as breast lipofilling which can help increase breast volume and projection. This is usually done through tiny incisions with minimal scarring. It also allows improvement of contour in the areas where the liposuction is performed in order to harvest the fat for transfer.

It is a relatively safe procedure with low risk of complications. In general, about 50-70% of transferred fat will survive after the surgery and the fat that does survive will act like normal fat. Often, more than one fat transfer session is required to achieve desired results.

I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast surgeries to further discuss your options, specific techniques, concerns and expectations. 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.

I hope this helps.

Best, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship Trained
Board Certified Plastic Surgeon
Queens, New York
(516) 833 0309