Do I need a breast lift with implants or just implants to fix my issue? (Photos)

Your breasts are low on the chest wall and you would benefit from a lift more than augmentation.  Augmentation alone will result in low large breast.  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 and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

The best procedure for you is dependent on exactly what your aesthetic goals are. Based on your photo, I think that you are a candidate for a breast lift. A breast lift will address any sagging skin/tissue and improve your overall breast shape. If you are looking for an increase in overall breast volume or upper-pole fullness, a breast lift with implants is a good option to consider as well. I recommend setting up a consultation with a board-certified plastic surgeon to discuss your options. Best of luck!

Hello and thank you for the photos. As you just stated in your post, your breasts are sagging and low on your chest wall.... plus your areola position is on the lower half of your breasts. This is called Breast Ptosis and you are at, or very close to Grade 2 Ptosis. This means that implants alone will not lift them. You are actually a great candidate for a breast lift with small implants. I think an anchor lift is necessary if you want the most perky results possible.
The correct size implant is chosen after a careful physical evaluation, with measurements and sizers to give patients a general idea of their outcome. That said, I feel that 300cc implants plus a lift will be more then enough to achieve your desired results.
Best of luck on your procedure! Dr. Miguel Mota                                                                                                                                 

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  Based on your photographs, the best shape and contour could be achieved with an implant and a breast lift. A large amount of your breast sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A breast lift with an implant can result in a very nice shape if good technique is used.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   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.  

Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

Dear Kh305,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello,Thank you for your question. You may achieve the best results by the Breast Augmentation combined with the breast lifting. The ideal size can be set only during in person examination taking into consideration your chest wall, weight and body proportions. The decision of the implant's place made depending on your breast tissue. I personally prefer inframammarial approach, which is also the most common technique in the world, as this allows the most beautiful shape of breasts on one hand and minimizes potential complications in the post-operative process on the other hand. To find out more please click on the attached link. 
Best regards 

A breast augmentation and a breast lift work hand and hand to enhance the overall shape and size of a woman’s breasts. These procedures are ideal for increasing the size of the breasts while restoring balance and youthfulness to a woman’s bust.
The augmentation lift can help eliminate the sagging skin and excess fat causing your breasts to develop a droopy look. It will give your breasts an uplifted appearance and a more desirable sloping shape.

It may be possible to achieve your goal with implants alone. Although implants do no lifting, they often provide the illusion of a lift. I recommend an in person evaluation with a plastic surgeon to be measured and discuss your goals. After I do this I review pictures with my patients of patients with similar measurements and different size implants.  My patients tell me this process is very helpful in determining what size implant and surgery is right for them.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author
RealSelf Distinguished Hall of Fame Inductee

Your breasts are sagging now and implants will just give you larger and still sagging breasts. I would suggest a lift and avoid large implants. Your own tissue is what must support the weight of your breast.

Keep in mind that nothing replaces careful in person evaluation when it comes to providing patients with specific/meaningful advice.  Also, keep in mind that receiving differing opinions from plastic surgeons is the norm.  Generally speaking, exactly what operation an individual patient should undergo, will depend mainly on her concerns regarding breast appearance and her desired outcome (goals).   
 Having said the above, based on your photographs and description of concerns/goals, I think that you  will  likely benefit from breast lifting, as well as breast augmentation surgery.   Keeping in mind that in order to achieve more "fullness", your breast size will be increased. Breast lifting alone will not achieve a more full look.  On the other hand, breast augmentation surgery alone will not truly lift your breasts.
Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.
 
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate. 
To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications. 
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. 
Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc). 
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
 
 
 My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well.   In our practice, this is best done with the help of goal photographs and computer imaging.  
Working together you will come up with a good plan to achieve your goals  Best wishes.