Can my breast be helped? They are deflated 36C and I want D or DD.

Question

I am only 25 and breastfed one baby. When I lay down they are flat with no firmness! I want to know what size looks right for me and what type of implant to get! I appreciate the help :)

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, the best shape and contour could be achieved with an implant
and a breast lift. Your nipple sits below the inframammary fold and
without a lift in addition to the implant, this will not have a natural
shape.  A breast lift with an implant can result in a very nice shape if
good technique is used.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Daniel Barrett, MD · Answer

Dear KitCat18,Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I do this with my patients, we then look at pictures of women with similar measurements with different size breast implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Curtis Wong, MD · Answer

With your skin laxity and depending on your expectations, do not be surprised if a mastopexy or breast lift if also recommended.  This will impact your ability to breast feed so you must be okay with that before jumping in feet first.  As for sizing, I like external sizers as they have proven to be accurate in my practice (I always add 10% of the sizer volume to choose the implant volume) as  this allows you to see what you will look like.  Best wishes with achieving your goals!

Joshua A. Halpern, MD, PA · Answer

In regards to size, Mentor makes a great sizing system which patients find very helpful when choosing the size implant they want to go to. Special sizers are put in a bra. You then can look at yourself in the mirror to get an idea of how the different sizes will look on you. In addition, I have many different size patients in photo galleries that patients can look at. They can see how patients who are similar to them before surgery will look after surgery. Implants come in saline and silicone. They come in round smooth versus textured versus shaped. In addition there are different firmnesses for implants. Unfortunately we do not have the space to discuss all the options in detail. It also appears from your pictures that you may need a breast lift. This will need to be confirmed by a physical exam. If your nipple is above your breast fold, then you may not need a breast lift at all. A breast enlargement will lift your breast in this situation. If your nipple is lower than your fold, you may be a candidate for a donut breast lift. Here the incision goes area the nipple areolar complex. If your nipple is lower than this, you may need a lollipop or anchor lift. The former incision goes around your nipple areola complex and down the middle of your breast. The later includes the former with an incision in your breast fold. I hope you find this information useful. Please watch the enclosed video.

Michael C. Edwards, MD, FACS · Answer

It depends on what you hope to achieve. A breast lift alone (mastopexy) will lift your breast making them less saggy but they will be a little smaller as a result. Addding an appropriately chosen implant to a breast lift will give increased upper breast fullness and make your end result a larger, lifted breast. Please only see board-certified plastic surgeons as you decide who would be the best to take care of you. I hope this helps.Dr. Edwards

Eric YK Li, MD · Answer

Based on the photos, I believe you will benefit from an augmentation with a mastopexy.  The augmentation will restore your fullness and firmness, whereas the mastopexy will reposition your nipples in a higher position and remove the excess skin.  
In terms of determining the right implant for you, it is a complex decision and the process is best done through an in-person consultation where sizers, computer imaging, and your surgeon's advice are all available to you to help guide your choice.  
Hope this helps!  As always, seek proper consultation before treatment and best of luck!

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. Based on your photographs, I think you will benefit from breast augmentation/mastopexy lifting) surgery. Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars.
 
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work. 
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "D or DD cup" or "looks right for me" etc may mean different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.

Mary Lee Peters, MD (retired) · Answer

Thank you for
providing the pictures.  Your treatment will depend on your personal goals
for your final appearance.   You have some ptosis (sagging of the
breast tissue) that could be improved with a breast lift.  A breast lift,
also called a mastopexy, will restore your breast shape to your pre-pregnancy
shape and elevate your breast tissue to where it
belongs.  If you want to be bigger than
your current size, you will need a breast implant.  You and your surgeon can discuss implant
selection for shape and size.  You should
also discuss the pros and cons of doing a breast lift and augmentation during
the same surgery.  Best of luck to you!

Jon A. Perlman, MD (retired) · Answer

Thanks for your question and photos.  You do appear to be an excellent candidate for mastopexy and placement of breast implants.  My preference for the latter is the use of mid-profile Allergan brand Inspira cohesive silicone gel smooth round implants.  Occasionally we do use high-profile implants for larger sizes.  Keep in mind that your breasts will change again with future pregnancy despite the surgery so take this into consideration.  My preference is to choose the final implant size on the operating table when test implants called sizers can be inserted and your actual size, shape, and contour can be evaluated.  I think that this allows for the selection of the most optimal implant for the individual patient.Be certain to meet with an ABPS board-certified plastic surgeon and review many before and after photos before proceeding.  Best wishes,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd

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