Do I need a lift and if so what type? (photos)
Doctor Answers 9
Borderline for a lift
Assessing by photos alone is difficult as you look borderline for needing a formal lift - the photos of other patients you have posted look less droopy than you but you are certainly mild only and you will still get a good result with implants alone if they are kept fairly low along with your breast footprint - in doing so the implant possibly with the addition if an internal lift will support the breast
Do you need a lift?
Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.
See the below link on some suggestions on finding the most qualified Plastic Surgeon for a Breast Augmentation.
Do I need a lift and if so what type?
Thank you for your question. Based on your photos which show pseudootosis, you may require a limited breast lift (donut or lollipop) in addition to implant placement. Be sure to consult with an experienced board certified plastic surgeon. Good luck!
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A face to face consultation with a board certified plastic surgeon is best so that you and your breasts can be carefully examined. This will allow the surgeon to assess your skin tone and quantify the amount of sagging in each breast. Treatment options can then be carefully reviewed including the specific type of lift procedures.
Thank you for your question and photographs.
I would recommend that you schedule a consultation with a board certified plastic surgeon to have an examination of your breasts done. At that point, the surgeon can recommend whether you need a breast lift, breast augmentation or both. From the photos you have posted, it is hard to accurately determine whether a breast lift is necessary, a breast augmentation with implants may be sufficient to correct the sagging appearance and add projection and volume. It may be a case of giving your permission for the surgeon to determine during the surgery if a lift is necessary after he places the implants. At my office, we use Crisalix which is a virtual reality device that will allow you to view what your breasts would look like after a lift, or view different sizes of implants and pick which best suits your desires. As the only board certified plastic surgeon in Pittsburgh offering this virtual reality imaging system, we have a 100% satisfaction rate. Crisalix is truly a unique experience for our patients as they can view themselves using virtual reality goggles and can instantly visualize their own breasts changing in size and shape with all of the various brands, sizes and shapes of breast implants. Thus, our patients leave the consultation feeling confident with the size of the implant they chose.
Best of luck in your endeavors!
James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science
Do I Need A Breast Lift (Mastopexy) Or Just Breast Augmentation?
The confusion is that in your case, there is more than one way to a good outcome. Your breasts are in that gray area – your nipples are above your breast crease and appear to be in good position, but some of your breast tissue hangs below your crease - not a lot, but it's there. Remember that you can always add a scar, but you can't take it away. You may want to go for a breast augmentation first and see how you like that look. You can always add on a breast lift later if necessary. Yes, this means you will have two separate procedures, but there are some plastic surgeons who won't perform the procedures together anyway. Personally, I believe combining the two procedures should be on a case-by-case assessment, not just on an a priori decision. Furthermore, in terms of the type of breast lift/mastopexy, I find that a Benelli/periareolrperiareolar/donut lift often flattens the breast projection because it is only shaping the breast in one dimension. So yes, while there is only a scar around the areola, that scar itself tends to widen and that particular breast lift tends to flatten the final breast shape - like a sports bra would. If you like the perpetual flat-breasted sports bra look, then that might be the choice of breast lift for you. Only an inperson evaluation can give you the best personalized advice. And definitely do not go to a surgeon that does not know how to do a breast lift. It is quite suspicious that a surgeon would offer "breast surgery" but not include breast lift/mastopexy in his/her toolbox/arsenal. One final tip – look for long-term postoperative photos, not just photos that are < 6 months or less. You want to see how the surgeon's work looks long-term, not just in the few months after surgery. Inevitably, though, gravity always wins and you will need a repeat breast lift in the future. Best of luck to you!
You probably won't need a lift if the right implant is selected and placed properly
It will be impossible to tell you whether or not you will need a lift for certain without a physical exam, and this is part of the issue with the two "online assessments that you have had as well. I would not make any final determinations about this issue without a good exam with measurements and assessment of your tissue tone and integrity. Having said that, I can tell you that my general rule of thumb is that if the nipple is at least 2 cm above the level of the inframammary fold, the fold below the breast, we can rest assured that an implant alone would produce a good result. If the nipple is at or below the fold, you will likely need some form of lift to get the best result. This, of course, is a general rule of thumb only, and many other factors come into the decision too, like your personal preferences, the size of implants desired, and your tissue tone. With these things in mind, it looks as though it is quite possible that you could achieve the result you are looking for with just implants. It will be important for you to schedule consultations with board certified plastic surgeons who also do a lot of breast surgery, including lifts. You stated that the one surgeon you have seen face-to-face doesn't do lifts, and I would be concerned about that, as you may be getting a biased opinion from someone who simply can't offer you all of the options available to you. It may be that you don't need a lift, but that decision should come from someone who does them and knows for sure why you don't. This will be the only way you will learn about all of your options and which is best for you personally. In addition to being certified by the American Board of Plastic Surgery, your surgeon should also voluntarily participate in the Maintenance of Certification program administered by that board. This is the best way to know that your surgeon not only has the best training and experience for the procedure, but that he or she has maintained currency in the certification requirements as opposed to practicing on a "lifetime" certificate which has only been reviewed once at the beginning of his or her career. For more information on this you can visit ABplsurg.org, ABMS.org, and certificationmatters.org . Good luck.
Breast lift options
I believe the reason you are getting multiple opinions is that you are a "gray area" case that might do fine with implants alone, but may also need a lift. You appear to have glandular ptosis (some breast hangs below your inframammary creases, but the nipples are in a reasonable position above the folds). You might be able to fill out the lower skin excess with an implant and a dual plane 3 dissection, but there is a good chance that need a lift depending on how the breasts shape up with the implants in place. It is obviously harder to tell by photos only, but that is my best guess based on your pictures. For patients in your situation, I usually schedule surgery to allow enough time for a breast lift, but start with the implants only and see how the breasts look with the OR table in a seated position. If things look good, I stop there, and if there is still a droopy appearance, I would proceed with a lift (probably circumareolar vs vertical scar in your case). I certainly would not recommend that you go to any surgeon that "doesn't do lifts". You need to have a surgeon that is able to perform the full array of breast procedures so that you get the surgery that is best for your anatomy, not what is simply within their repertoire. Good luck!
Lift or Not
Well firstly if the doctor you saw doesn't do lifts then they are probably not a plastic surgeon . Might be wise to check out their qualifications on the AHPRA website .
The answer to your question is more complicated and depends a lot on your breast measurements and your desires .
If you have a consultation with a Vectra 3D imaging it should be possible to advise you as to the likely outcome with or without a lift .
That way you can weigh up the benefits of the lifts versus the extra scarring .
I suggest you get a face to face consultation with a qualified plastic surgeon .