Replacing Silicone Breast Implants with Moderate Sagging

I currently have 270cc silicone implants that are 30 years old. No problems ever! I am interested in a lift though, but do not want the scars. With moderate sag, is it possible to just replace with larger implants to increse overall fullness?

Doctor Answers 15

Larger Implants for Fullness, Not Lift!

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Larger implants can provide more fullness, but implants do not lift a droopy breast!

Be certain that the added volume will not make you feel too big.

Also consult with your surgeon to be sure you don't have too much sagging to just add volume and end up with larger, still saggy breasts!

Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Breast Implants and Sag

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As some of the other plastic surgeons have noted this can be a difficult problem. The issue is how large an implant would be required to correct the amount of sag you have.

Plastic surgeons grade breast ptosis (sagging) by comparing the position of the nipple to your breast fold. If your nipple is completely below that fold with the implants you currently have then it is likely a larger implant will not be enough to get you a good result.

Some plastic surgeons will stretch the limits of the correction an implant can accomplish by performing a peri-areolar mastopexy. Essentially this creates a purse string incision around your areola to decrease the amount of skin envelope. The problem with this technique is it typically is not very lasting and the scars - while limited to the areola - can be quite prominent and can widen.

The best course of action for you should be discussed in depth with a board certified plastic surgeon.

I hope this helps!

Going bigger may be a trap

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The danger of placing larger implants to overcome "droop" can be a trap. The breasts can appear larger, but still saggy. Or the nipple-areolar position can become located on the bottom of the breast, making them appear aged.

A board certified plastic surgeon can discuss with you the options based on your measurements, particularly the nipple to notch distance. If this is too great given your frame, you may want to avoid the "larger is better" philogophy.

All breast lifts leave scars of some type. Many patients opt for an around-the-nipple lift, hoping to avoid the scars of a Wise pattern or anchor lift. This in turn can create its own problems, with the nipple remaining large... and still droopy. No doubt your doctor will also want to consider the remaining circulation after your surgeries, especially if the implants were placed above the muscle (this reduces the circulation of the breast, and especially of the nipple).

Also a factor is how larger breast implants will look in a patient who has most likely been losing breast tissue as the years pass. Will they ripple more or be more visible? All questions to ask.

The best candidates for the procedure you describe are women who have had loss of breast tissue, and the breasts now appear droopy. However, the distances the nipples have actually fallen are minimal.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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You can consider an INTERNAL lift with larger implants

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To cherabine,

Hi. If you don't want scars, you cannot have a regular breast lift. A regular lift places scars around the nipples and sometimes, in a "lollipop" pattern.

But, depending on your anatomy, you may be helped by an internal lift and larger implants. This will not work if you have a lot of sagging.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Yes there are internal lift and different model implants that can help you.

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Dear Cherabine:

I agree with Drs. Rand and Goldstein for most patients who have a significant drift of the breast complex (including the nipple/areolar complex - NAC) over the implant. Sometimes the appearance of drift may be from a subtle capsular contracture which has elevated the implant above the NAC giving it the 'snoopy' look.

Interestingly, this effect is the principle behind the 'internal mastopexy' which leaves no external scars, and is a type of 'gathering' or 'plication' of the central and superior portion of the internal capsule towards the collar bone with a purse-string suture providing a mild 1 - 2 cm 'lift' of the NAC.

I had a patient with a 20 yr textured saline implant that 'didn't move' even though it was above the muscle, and her NAC had drifted below the central mound Dr. Rand refers to. All I had to do is re-dissect the anterior portion of the capsule surrounding the prosthesis to 'recreate' the pocket, place the pursestring sutures and add the new smooth cohesive gel prosthesis - she was a different woman in less than 2 hrs!

When you combine this subtle 'lift' with a slight lowering of the inframmamary crease (IMC) and a slightly wider, low profile, smooth surface, new gel implant design you can maintain your current texture while 're-aligning' your breasts to a more youthful position for years to come - without any new scars!

Dr. C

Antonio M. Carbonell, MD (retired)
Raleigh-Durham Plastic Surgeon

See a qualified plastic surgeon to investigate what method is best for you.

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You have asked a very important question--unfortunately, there is not one simple answer. Most women desire a natural look and feel to their breasts. There are many factors that come into play when determining whether or not a breast lift is required.

I would strongly urge you to see a board certified plastic surgeon that is experienced in breast surgery, specifically breast augmentation and breast lift. Options are available to you that may allow you to avoid a breast lift.

Your physical findings and characteristics are so very important in determining what method is best for you. If the degree of breast sagging is slight, changing the size of the implants for larger ones may improve your appearance of breast sagging.

The position of the implants may play a key role in avoiding a breast lift. Sometimes, placing the implants on top of the muscle in the subglandular position may help. In general, if one has moderate or severe sagging, usually, a breast lift procedure (mastopexy) must be performed to correct this feature. See a qualified plastic surgeon to investigate what method or technique is best for you. Above all, remain prudent and be sensible.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Possibly, depending on your expectations

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The "need" for lifting is dependent on the position of the nipple areola in relation to the crease along the bottom of the breast. The best looking breasts are ones where the nipple is on the front of the breast mound, pointing forward and not downward, and well above the crease. Often, just replacing implants cannot improve that nipple to crease relationship and a lift is needed to create the best result, although with the scars necessary to perform the lift (there are several scar patterns available depending on how much lifting you need). The lift is to make you look better out of clothes while the volume of the implant is basically what people recognize in your clothing. So, if you would be happy with the look of unlifted breasts, don't do a lift. It can always be done later. On the other hand, maybe you don't need a lift anyway - I would need a picture to tell. Just know that an implant of any size, above or below the muscle, can't lift your nipple areola, it can only add volume to your breast.

Moderate breast sagging can be camouflaged with a breast implant-the bigger the better.

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Many patients have breast that sag of their own weight or because of pregnancy.  Breast implants can augment total breast volume and camouflage the droopiness (ptosis).  This applies only to those patients where the problems are modest.  Generally placement of the implant above the muscle camouflages better than below.  Also, the larger the implant, the better the result.

Lifting with placing larger implants

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Depending on the severity and complexity of the case, you may be a good candidate for lifting with implants alone. This will depend on the location of the nipple-areola complex and what look you want to achieve. If it needs to be raised then you will need additional incisions to provide a lift. There are 3 different incision types, each providing a different type of lift. The "donut" incision involves an incision around the areola, providing a limited "benelli" lift. The "lollipop" incision involves an incision around the areola and a vertical line. And lastly, the "anchor" incision involves an incision around the areola, a vertical line, and a horizontal line underneath the inframmamary fold. I suggest consulting with a board certified plastic surgeon to discuss the best and safest possible options for you. Many women choose to remove and replace their current implants for larger ones with no problems. A photo may be more helpful for us to determine which would be best for you.

Larger implants do give a modest "lift"

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As you age, the skin of your breasts loses it's elasticity and often the nipple drops. This is known as breast ptosis (droopiness). Correction requires either increasing the volume of the breast or reducing the skin envelope to recreate a perky breast. Of course, a combination of the two will also work.

If you increase the size of your implants, it will tend to give you a "lift" by filling out the skin and increasing projection. This usually is adequate only if the amount of sag is small. For moderate ptosis , larger implants combined with a tightening of the skin around the areola (periareolar mastopexy) may improve things considerably. You need to be wary however of increasing size only to compensate for loss of elasticity. Sometimes this simply results in larger, ptotic breasts.

Breast surgery of this kind can be quite challenging and it's important for you to see a plastic surgeon with a lot of breast surgery experience.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.