Breast Lift with Implants or Lift Alone
Thanks for the question. Your case is complicated by the mild droopiness, moderate emptiness and significant asymmetry in size and skin surface area of your breasts. You need a lengthy discussion in a face to face setting of reasonable goals and expectations as well as priorities such as surgical incisions, scarring and types of implants. Personally I'm uncertain why you're thinking in terms of HP saline implants in preference to silicone cohesive implants. Your example patient is of course wearing support, has implants above the muscle and in a few years may be suffering from rippling, tissue thinning, etc, possibly regretting her decision. Just some food for thought.Good luck and get several opinions.
Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Best of Los Angeles Award 2015, 2016
Beverly Hills, Ca
Research Question Before Surgery: Do I Need a Lift or Will an Augmentation Be Sufficient?
Any implant will give you the After appearance in a bra. But without the bra, the basic criteria for a lift is the relationship of the position of the nipple with respect to the inframammary fold. Additionally if the distance between the nipple and the fold is more than about 9.5 cm, then the nipple should be above the fold for a large implant to lift it forward and upward to avoid a snoopy appearance. In the picture shown, the left breast appears to have the nipple at or above the fold, but the right breast does not and without a lift a high profile implant will cause more of a snoopy deformity than even a moderate profile implant will. High profile implants give a lot of forward projection, but at the cost of giving a pretty unnatural abrupt step off appearance to the top of the breast. An appropriately sized moderate profile implant such as an Allergan Natrelle or Inspira can give a full found breast, and if a lot of upper pole roundness is desired, the size can just be a bit larger than the size that will give overall roundness without excess upper pole roundness. This can be determined based on breast width. The breast will never look like it does in a bra, without a bra, neither with respect to cleavage nor upper pole fullness. That can't happen anatomically. Different size implants are useful if the breasts are different sizes in terms of total volume. They would not be used to influence the position of breasts that are asymmetrical with respect to sagging but not in volume.
Breast Lift with Augmentation
Thank you for your question and for posting appropriate pictures. You seem to be a great candidate for a breast lift with implants. This procedure will help address the asymmetry and droopiness that can occur after pregnancy. High profile implants may be right for you in order to give you additional fullness and lift. I recommend undergoing Vectra 3D imaging to get an idea of your post procedural results and to "try on" different types of implants. You will need to have a consultation with a board certified plastic surgeon for precise recommendations.
You are correct in that your right breast is larger and lower. To even things out a lift and augmentation is what I would recommend. The incisions would be the same and the right breast could slightly reduced to even things out more accurately than different size implants.
Breast Lift/ Augmentation
Based on the photos- it appears that your sagging would be best addressed with a lift, then implants. The lower side especially cannot be corrected without a lift. I recommend that you meet with a Plastic Surgeon in person so that they can examine you, discuss your goals in detail and then present the best options.
All the best
Thank you for your question. By the look of your pictures, I believe you would benefit greatly from a breast lift and augmentation to achieve the look you so desire. An implant under the muscle would be your best choice. Please consult with a board certified plastic surgeon. Best of Luck!
You have some questions to answer to best determine what will be recommended...
if you want as close to perfect as possible, you will benefit from lifts and a small reduction on your larger side so the same sized implants can be used. If you're accepting of the wait and see approach, you could have your augmentation first (using same sized implants or different sized implants to even things out a little but perfectly equal cannot be achieved) and focus on getting the upper pole you want (so don't lower your breast fold) then coming back if you need it to have the touch ups done. Make sure your surgeon understands your goals and that he/she can reasonably achieve them.
Doing my research :) Before I get consultations I want to see what I'm looking at. Do I need a lift? Or just a BA?
From your photos, I believe you will not be happy without a breast lift, along with breast augmentation. Even with a very large implant, you will have sagging and breast asymmetry without the lift. Also, given the size implant you are considering, a silicone implant will probably maintain its shape and will have a decreased risk of deflation as opposed to a saline implant. Best wishes, Dr. Lepore.
Implants alone? or with a lift?
Thank you for your question and your photos. Given the size you are looking to achieve, you could select implants alone or implants with a lift depending upon your exact goals. You have significant breast asymmetry, which would not be well addressed by implants alone. Given the complexity of your case, this would be a good discussion to have in an in-person consultation with your chosen plastic surgeon. In terms of implant selection, given the wish photo you have provided a high profile saline implant is the most likely to create that look. Depending on how much tissue you have in the upper part of your breast (you need an in person exam for this)- you might be at high risk for implant visibility or rippling. In that case, you may want to select a silicone implant. Again, this is quite a lengthy discussion of pros and cons that can be had at your consultation. Best wishes, Dr. Meghan Nadeau, Seattle, WA
Hello and thanks for your photosWhen you consult with your plastic surgeon, you can discuss both options (lift vs no lift) so that you understand the pros and cons of each.With the amount of asymmetry you have and the deflation of your tissues, I would be inclined to suggest lift plus implants if you were my patient. I think it would be difficult to get good symmetry with implants alone.It's also important to understand that while you may be able to achieve the size of your wish photos, you will not be able to achieve this type of shape - though you may be able to push things up in clothing with a lot of support.I would also discuss different implant types with your surgeon - stay open minded to the cohesive silicone option, as it feels much nicer than saline in most cases.Best wishes-