Pseudoptosis options? (Photo)

Thank you for your question. My inclination as a first step would be a breast augmentation alone. This may give you the 'lift' you need without the scars of an actual breast lift. This approach does not burn any bridges or prohibit a mastopexy in the near or distant future. Good luck and I do recommend you see board certified plastic surgeon.

You would need an in-person exam with a board-certified plastic surgeon to get the best options for you.
Your nipple position is fine, so it does not appear any elevation is needed. Your skin envelope is stretched out, mainly on the bottom, as you were an "h" during breast feeding. A 600 cc implant in a stretched skin envelope will continue to stretch and would even if you had some skin removed in the lower pole. It looks like any vertical excess is below the nipple, and removing that if desired usually is best done with an inframammary incision. Your surgeon would like to know your nipple to fold distance. A donut lift could take a small amount of vertical excess below the nipple, and then determining the size that you would like be the next step. Be advised that a donut lift, tends to stretch out the areola, particularly with a large implant.
Since you are on the small size, being a 32, a 600 cc implant, would seem inadvisable due to stretch problems down the line.

The technique I recommend is a lift using 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.

Your nipples appear to be above the level of inframammary fold, which means that you have pseudoptosis (deflation without sagging). Correction with breast implants would create excellent result without need for lift. Good luck.

Dear Pioneering030320,
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

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. They then get to choose what looks right for them. 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

Your nipples are in good position, but you do have some sagging inferior breast tissue. You will probably need the vertical lift.

Not sure you really need a lift in the traditional sense. What can work well for someone with you lower pole stretch but a normal nipple position is to excise skin horizontally along the crease to work that out rather then a vertical or T scar . This would be something I also might suggest using some absorbable mesh (Galaflex or DuraSorb) mesh to reinforce that position

You absolutely could NOT use a 600cc implant in you. Would be orders of magnitude too large and would likely recreate your issue. With your frame a large implant would be in the lower 400cc range

Based on the nicely posted photos I recommend doing dual plane 600cc implants with maybe donut lift. Best to virtual consult with… Fees from $5,000-$12,000

Hi and welcome to our forum!From your photos, I note that your breasts are relatively symmetric, the nipple areolar complexes are at the same "altitude" on the chest wall, the distance from the top of the breast bone to the nipples is increased, the distance from the nipples to the fold beneath the breasts is increased as well, and you have lost superior pole breast volume. The nipples reside above the fold at the bottom of the breasts and you demonstrate minimal-moderate breast sag. You are demonstrating true ptosis. A donut lift will only lift the nipple areolar complex 1 1/2 - 2 cm. Attempting more risks pancaking of the breast, a serrated scar (from suturing a larger circle to a smaller one), and a suture pull out from the areola resulting in late areolar enlargement. If a relatively small implant is utilized, a breast lift will be required. It will elevate the nipple areolar complexes into anatomic position, will remove excess skin, will increase superior pole breast volume, and will conify the shape of the breasts. If a 600 cc implant is used, however, you may not require a lift but you should be aware of potential problems large breasted women may face, including neck pain, shoulder pain, back pain, bra strap grooving, and summertime rashes under the breasts.It is often best to remain proportionate.Best wishes...