Breast Lift Timing - Best Results in Regards to Symmetry and Scarring? (photo)

I'm replacing my 450cc sub-glandular salines with 255cc silicone, partial sub-muscular and a lift. I am staging the lift to stave off any possibility of nipple necrosis (I have thin skin). Will I have a better chance of achieving symmetry and favorable scarring if I replace the implants at the time of ex-plant and do the lift later, or if I simply ex-plant, and do the re-augmentation and lift at the same time?

Doctor Answers 6

Staging breast lift surgery

It is acceptable to have your lift and downsizing either as one or two stages.  Performing it in two stages does make it safer and more predictable in some cases and there is nothing wrong with that.  The most important factor is to use a surgeon who has plenty of experience with cases like yours.  As Dr. Baxter points out pre operative per cutaneous deflation of the implants is also a great way to start out. It allows for some tissue retraction  and makes the planning of your future surgery easier.

San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Lift Timing - Best Results in Regards to Symmetry and Scarring?

Do lifting first to see if you like the results as for size. You might be surprised that you might like the results, than no need to exchange implants,.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Options for staging implant exchange and breast lift

There are a couple of reasonable options for you to consider, but I would favor implant exchange first then lift later. Another option is percutaneous deflation of the implants without removing them, allowing the tissues to retract to some extent which may minimize the need for the lift later, and allow the space around the implants to collapse somewhat to adapt to the new smaller implant size. It might be reasonable in this scenario to place the new implants and do the lift together, but that is a judgment call. Regarding fat grafting, I would ask to see what the surgeon's personal success record is with getting 255 cc's to reliably "take" long-term. With implants you know exactly what size and shape you are getting.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Fat Transfer, Breast Enlargement

My first question is why would you take on all the maintenance hassles of silicone breast implants?  Remember the FDA and the manufacturers strongly suggest you have an MRI (about $1000 cost) the third year after surgery and every other year thereafter.  I also recommend replacing your silicone gel implants every 10 years before the fail.  The reported incidence of silicone gel implant failure to the FDA is around 10% during the first 10 years.   Understand that when a silicone gel implant fails a small amount of the gel regardless of the viscosity leaks out of the implant and causes low grade chronic inflammation around the implant.  This inflammation can make replacement a real problem in the future.  Saline implants give you peace of mind in that when the fail there is insignificant inflammation around the solid silicone which remains after the natural saline is absorbed.  Finally, you do have the choice of fat transfer.  A natural fat graft can be used to replace your implants entirely.  Your choice of 255 cc is modest and should be easily achieved with a fat transfer.  In addition, you get the benefit of liposuction somewhere else on you body.  Best wishes.

Ralph W. Bashioum, MD
Minneapolis Plastic Surgeon
4.2 out of 5 stars 17 reviews

Staging is essential

Your photo appears to show expansion of your nipple-areolar complexes, which is a function of the subglandular plane, a large saline implant and thin skin.  On the other hand, the nipple position doesn't appear to be overly low, in relation to where the breast meets the chest wall.  I would favor explantation first, to allow your skin to retract and for you to evaluate what type of mastopexy is needed. I think that you may be pleasantly surprised that you may need a shorter scar technique if several months intervene between the removal and reaugmentation. In my experience, I have attended women who explanted saline implants before pregnancy in an effort to avoid mastopexy.  In many cases, this strategy has been successful.  

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Breast Lift Timing - Best Results in Regards to Symmetry and Scarring?

     I would do the replacement and the lift at the same time.  I have never had even a partial nipple areola necrosis doing hundreds of breast augmentation and lift combination procedures each year.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

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.