46 y/o hoping to go from a B to DD cup - can this be achieved with implants alone or will I need a lift as well?

Implants alone provide volume but very little lift. It is likely that with implants you can achieve your volume goals, but they will not pull up the bottom of the breast or correct the sagging. If that is important to you then you will want to consider a lift. Seek a consultation with a board-certified plastic surgeon who can exam you, then provide realistic expectations for your outcomes, with and without the lift.

Hello, thank you for your question. If your are going to go sub muscular, you may want to consider the breast lift as well because the muscle supports the implant and it may sit higher on your chest wall than your natural breast tissue. It can definitely be completed at the same time. Speak to your plastic surgeon about your options.

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants, if interested. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

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 (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

I think a lift with implants would be the way to go. I would do what is ssh unstinted called the lollipop lift in your case and about a 325 c.c Implant

With just implants, you will have larger and still sagging breasts. I recommend the lift, but suggest not larger than a D to avoid future sagging.

A breast lift is indicated if your nipple is significantly lower than your inframammary fold. Aggressive augmentation in conjunction with a mastopexy increases the chances of complications.
I suggest having multiple inperson consultations with local board-certified plastic surgeons in your community to get a better understanding regarding your candidacy for surgery and understanding surgical options.
Some plastic surgeons may prefer to do these stage procedures, especially when using very large implants.The bigger the implant, the more your breast I’m going to look like implants.
If you want a more natural appearance, then stay with more modest size implants.
Best,
Mats Hagstrom, MD