Thank you for your question and photo. A breast lift with implants would give you the best result. The shape of the breast will trump the scars. Scars will fade and become less noticeable over time. Please consult with a board certified plastic surgeon to fully discuss your questions. Best wishes.
Your nipples are pointing downward, they're below the breast crease and you have little fullness in the upper pole. This makes breast lift surgery your best option if you wantfuller breasts. Implants alone will just highlight the sagging and they'll sag even more because of the additional weight of the implants.
A woman who’s had a pregnancy. Maybe her breasts has become either just deflated, or
the skin has been stretched from pregnancy, and or breastfeeding. And now is in
a lower position than she would like. So by doing the breast lift, we can
tighten the breast.
This will provide the best shape.
550 cc implants weigh over 1 lb each, will displace
inferiorly and laterally requiring revision.If your breasts are hanging low now, the additional weight will make them
hang even further.Implants alone will
not be successful.Instead, I recommend
a new technique called The Ultimate Breast Lift™.The breast tissue is reshaped creating upper
pole fullness, elevated higher on the chest wall and more medial to increase
your cleavage.This technique avoids the
ugly vertical scars of the traditional technique, maintains nipple sensation
and the ability to breast feed.Implants
can be placed at the same time if desired.I always recommend small round textured silicone gel implants placed
retro-pectoral since they look and feel more natural, are more stable and less
likely to ripple or have complications needing revision.Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it.Unfortunately, you have not told us your bra
size but if you are 32 or 34 each 100 cc’s of implant corresponds to 1 cup size
change.If you are 36 or 38 each 200
cc’s of implant corresponds to 1 cup size change.From this, you can compute the volume
required to achieve your desired goal.
Gary Horndeski, M.D.
Your concerns about the results of the breast augmentation done without a lift are well founded. Although the best time to discuss this is after your examination, when your surgeon has had a chance to evaluate the position of your nipples in relation to the inframammary fold and the nature of your breast tissue, you appear to have enough sagging to need the lift, or your breasts will still appear saggy, though larger. I know you are concerned about the scarring, but lifts can be done through limited incisions and with good scar care can have excellent results.
It is always difficult to make recommendations from photographs.Barring a full examination, it seems plain that you need a mastopexy. A breast augmentation without correcting your droop is not a viable option. With your mastopexy, either saline or silicone gel implants would serve you well. You are considering quite large implants and it is important to understand that this will promote early sagging and a possible need for a secondary mastopexy.
A comprehensive consultation with a plastic surgeon, board-certified in plastic surgery, would allow you to understand the range of possibilities available for you.
From your pictures and your verbal description, I recommend a lift and a somewhat smaller implant in the dual plane position. Such a large implant in the subglandular plane is going to be a very short term fix. Your skin will stretch due the weight of the implant and you will likely need a lift at that time anyway. Placing the breasts in a better position now will give a better long term result, IMO
Although a subglandular position of a large implant may give an acceptable result, it will not lift your breasts, so they would be larger, but still not be perky. I think you would be better served with a lift at the time of your implants, and consider smaller implants. You have substantial amount of breast tissue, so with a large implant they will tend to fall with time.
You have listed some good questions and concerns. However, nothing will take the place of an in-person exam with an experienced board-certified plastic surgeon. He/she can do measurements, feel your tissues and show you comparable patients and their results.
Putting a HP silicone gel implant in the submammary will get you great lift for now. You may be fine with 400cc HP . This s close to an additional 2 cup sizes and will not stress the lower breast supporting tissues as much 550cc.