Weight loss caused deflated breasts. I don't want a lift. I want natural look, not 20 years younger breast (Photo)

Question

I'm 5'5 155lbs and 45 years old. I had my first Consultation today for implants. I have seen so many women with ptosis 2 sagging have nice results from dual plane implants. The Dr I consulted today coordinator quoted me for a lift and implant before seeing me over the phone. Today when i got to see the Dr he mention Ptosis 2 and also felt lift needed. I saw a paitent he did without lift Who's beast were more saggy than mine. Your opinion could dual plane round high help me w goal?

Ted Eisenberg, DO, FACOS, FAACS · Answer

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. 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

Leland Deane, MD, FACS · Answer

My approach, which has proven successful over many years, is to NOT COMBINE a lift with an implant. First, I determine if there is enough breast volume to give fullness. If the major problem is breast volume, then an augmentation should be done first. IF a lift is needed in the future, it is much more accurate if done as a second stage, and there will me less scarring and a much better shape. If there is enough breast volume to begin with, then a lift an be done first. Keep in mine that 'nation wide', a lift with an implant is the fast growing 'unhappy operation' there is, with a low satisfaction rate----and for good reason.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos, you demonstrate moderate ptosis (NAC appears to be slightly lower than your fold) with associated glandular ptosis/pseudoptosis. A lift would be beneficial. If you are hesitant, you could stage your procedures (beginning with an augmentation and following with a lift should you choose to).
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Daniel Barrett, MD · Answer

Dear cheriw46,

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

Brian K. Reedy, MD · Answer

Thanks for your question! I would recommend a lift for you. If you don't, your breast tissue will cascade off the implant and you will be bigger in a bra, but you will look droopier once its off. Good luck!

Leila Kasrai, MD, FRCSC · Answer

The implants need to be centred behind your nipples, which means they’ll sit rather low on your chest. As a result, a lift is recommended. Implants alone will leave you with a “rocks in socks” result.

Azita Madjidi, MD, MS, FACS · Answer

It all depends if you want the upper breast to be round or not ( push up bra look) . A lift alone will give you a nice natural breast look (flat on top, round at the bottom) without the fullness on top ( unnatural augmented look).

Ira H. Rex III, MD · Answer

I think ultimately you will probably want a lift.  An  implant sitting at the inframammary fold, where it truly belongs, would leave your breast tissue hanging off and look somewhat awkward.  An implant placed lower would probably make your nipples fall quite a bit toward the ground and look like a ball hanging off of your chest wall.  I him not being disrespectful at all, but this probably would not be satisfactory to most people.  One strategy would be to have the augmentation, and then consider the lift after living with your new result.  Good luck with everything!

Harry T. Haramis, MD, FACS · Answer

In my experience, dual plane breast augmentation can give natural results without a lift.

Breasts will not be high and perky but fuller and more natural without the lift scars.
Further exams and consultations with plastic surgeons until you feel comfortable are recommended to discuss your options and expectations.

Gary M. Horndeski, MD · Answer

Women refuse breast lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called 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 can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

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