Is over muscle no lift possible? (Photo)

Question

Surgery in 1 month, surgeons recommendation is 430cc OVER the muscle motiva ergonomix with no lift. I haven't sought a second opinion but worry I'll just end up with heavy droopy strapped on boobs. Everyone seems to have unders. I've lost 70kg, mother of 2 and have no intention for future babies but can't afford a revision surgery so would appreciate a second opinion. My request was full but natural looking breasts. Appreciate any guidance you can provide. Thankyou!

Ronald J. Edelson, MD · Answer

Not a bad idea to get a second opinion. You could stand to have a lift but it’s in the gray area. At least you should see what other surgeons think

Alan Gonzalez, MD, FACS · Answer

Hello @FindingMyBetterHalf thank you for your question and showing your pictures. It is important to make a surgical plan that takes into account weight, height and contour measurements and that the maximum time to change the prosthesis is 10 years, at the time of implantation. Best wishes! Alan Gonzalez MD, FACS.

Stefan Mark Szczerba, MD · Answer

That size will definitely fill things out.  I don't love on top of the muscle but understand that can work well.  I would definitely seek a second opinion and sit down with your surgeon to review before and after pictures.  Having realistic expectations on what works with each surgeon's technique and approach is the best way to go into this kind of surgery.  Best Wishes!!

John Michael Thomassen, MD · Answer

I agree you do not necessarily need a lift since your nipple/areola complex is at the level of the inframammary fold.  However, you may be better served with a partial subpectoral augmentation to give you a more pleasing upper pole, less risk of capsular contracture and no need for a special mesh/cost.

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Congratulations on you weight loss! great work! There are other benefits to going under the muscle, it adds support to the implant and less of a capsular contracture risk. You can go over the muscle and this may sit in a nice area for the short term period without any issues. As time goes one your natural breast tissue along with the weight of the implant may drop even lower. Yes if you are considering under plus a lift, it is the better way to go for the long run. Consider financing the surgery or waiting a bit longer to save up to have the entire surgery. Of course speaking to a plastic surgeon for a second opinion is another option as well. I would bring in your wish pics to the surgeon and see which approach will fulfill those expectations.

Gary M. Horndeski, MD · Answer

Your breasts are too low on the chest wall to undergo augmentation alone. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  One of the worst ideas that you can do is get a large implant on top of the muscle.  This 100% results in a or result.  Especially in your case where your skin tissues are somewhat lax.  You are an excellent candidate for a dual plane breast augmentation and lollipop breast lift.  Do not make the same mistake that many patients have made resulting in needing a second surgery.  Best wishes to you.

Daniel Barrett, MD · Answer

Dear FindingMyBetterHalf,
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

Scott W. Vann, MD, FACS · Answer

Your nipples are a bit low but still above the breast fold. I think you would do great with a dual plane augmentation which would give you all the advantages of under the muscle but would centralize your nipples without the scar or expense of a lift. I rarely put implants above the muscle since it looks less natural and increases chance of other complications such as capsular contracture. Discuss with your surgeon or consider second opinions. Good luck.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi
A subglandular approach is not a bad one but the problem is that the implant will sag with the breast over time. This adequately prevents a waterfall deformity however in my opinion the breast sits too low on the chest wall.  With experience I have found that the best method by far is a textured anatomical big ( ie around 450 cc) implant using a dual plane submuscular technique.  A minimal scar supra-areolar lift can be added to achieve a more optimal result.  It may be worth getting a second opinion if you are unsure.
Regards
Damien