What is your recommended technique for a breast lift and augmentation surgery to yield the best result? (Photos)

Hello: I am not happy with my appearance. I understand I would need a breast lift with implants to get anywhere near my desired state (current and "wish" pics are attached); however, I am concerned about maintaining a natural look, as well as "excessive" scaring. With these concerns in mind, 1) can you please recommend the best surgical techniques for a lift and implant; and 2) should both procedures be done at the same time? Thank you for your time and assistance.

Doctor Answers 17

Ideal lift

Expectations vary, but in a patient like you I would consider a Natural Breast Lift. This would include a circumareolar mastopexy, and a fat transfer. By doing this operation I suspect you would get a result close to your desired photo, but a bit smaller but less scared. The advantage of this operation is that there will be no implants to worry about, and later if a full lift and an implant are needed, you will not have jeprodized yourself.  See a board-certified plastic surgeon who operates at a certified facility and does a ton of this operation and you will be in good hands. Ask him or her how many of this operation have you done last year? Do not settle for vague answers, and you will be in good hands.


Waldorf Plastic Surgeon
4.8 out of 5 stars 26 reviews

Dr Kayser

Thank you for your question. You are an excellent candidate for a breast lift with implants. Based on your size, I do not believe that anything more extensive than a circum vertical or lollipop approach would be necessary. This would minimize scarring and also help to maintain the most natural shape as compared to the more traditional anchor or T scar approach, which tends to be boxyer in shape. The placement of an implant can be done at the same time or, if you prefer the most natural outcome, the use of fat transfer, which would also give you liposuction in the area from which the fat is retreaved, would be an ideal choice. In any case, I would recommend a consultation with a board-certified plastic surgeon who is experienced in all these types of breast surgery. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

What is your recommended technique for a breast lift and augmentation surgery to yield the best result?

Thank you for the question and pictures.  

Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery. In my opinion, you will not do well with breast augmentation surgery alone.

You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly. 


Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.


Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%. 


Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate. 

To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.


Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications. 



Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.

For example, some patients who wish to maintain long-term superior pole volume/"roundness" or "implanted look" may find that this result is not achieved after the initial breast augmentation/lifting operation. 



An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc). 



Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.

 

Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.

I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. 

The attached link may also be helpful. Best wishes.

What is your recommended technique for a breast lift and augmentation surgery to yield the best result?

Thank you for your question.  A breast lift with a vertical component such as a lollipop or anchor lift is likely necessary.  A silicon gel implant placed under the muscle which matches your breast base width is likely your best option. for more information please read below:

What is your recommended technique for a breast lift and augmentation surgery to yield the best result?

You will see that opinions differ but in my practice I would be discussing a full breast lift with an anchor pattern incision and placement of small or conservatively sized implants performed under one anesthesia.  Other well-trained plastic surgeons prefer to separate the procedures citing the increased risk of complications when done simultaneously but many of us have had good results as long as the goals are realistic set by the patient.  I would also suggest that you keep in mind the fact that the work is being done to improve your breasts but not to change them into someone else's who may be of a different age, pregnancy history or have other factors involved such as genetics and natural anatomy.


I would recommend that you meet with at least one or more ABPS board-certified plastic surgeon to get recommendations to allow you to make the best decision for yourself.  Best wishes,

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Lift and implants....

Of course, all goes without having the benefit of examining you and taking some critical measurements, but I think there are a few baseline recommendations:

1. Gel implants under the muscle- I think you would do well with either round or the shaped devices.  With poorer quality skin and tissues, I typically opt for a textured implant either way.  Looks like you could do a smooth round implant and get a beautiful result as well.

2. You MUST get a full lift- anchor incision or Wise pattern incision- they are all the same thing.  You would do terrible with anything short of the real deal.  If your measurements are great- I would prefer a superior pedicled lift.

You should get an amazing result.  Do not settle for anything less.

-JGH

Breast implant with lift

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  With that being said, based on your photographs, the best shape and contour could be achieved with an implant and a wise pattern 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 wise pattern lift with an implant can result in a very nice shape if good technique is used.  The size 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.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 78 reviews

Lift implant or both?

Thanks for your question. From your photos I believe you will really need a full mastopexy or lift. The scars will be a trade off that will have to be worth it to you. A full lift tightens the breast both horizontally and vertically. Because of that I feel it gives the best tightening and shape change. Vertical lifts alone can tend to leave the nipples too high. From the pictures, one side is droopier, but if it is also larger a small reduction could be done to help even out your volume. With lift alone you may be happy because you appear to have a good volume already. The lifted breast will be most natural, but will have a more tear drop shape than your wish pictures. Your wish pictures have more upper fullness that is consistent with an implant.

If you are on the fence about an implant do the lift first and see if it accomplishes your goals.An implant can alway be placed later and a staged implant will be more predictible.

Hope this helps.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 90 reviews

Breast lift with breast implant

You are a good candidate for a breast lift with a breast implant. This will bring you to your desired result. I would perform a small breast reduction with an implant. I would do this with a vertical scar that is shaped like a lollipop.  The reduction of the tissue would be to remove the saggy tissue so it does not sag again. The combination is very powerful and will provide you with an impressive shape. Both procedure can be performed at the same time with certainty if your surgeon is experienced.


Lift and implants

Thanks for your questions. It looks like you already have good volume in your breasts (similar to your wish pic), so you may only need a lift, and you also say you want to remain looking natural. However if you want to increase your upper pole fullness of your breasts, then this is best achieved by implants. To maintain an more natural look I would therefore put the implants under the muscles. If money and time are not option then have the implants done first, followed by the uplift. However this is rarely the case, and so the two procedures are normally performed together.

Anthony Barabas, MBBS
Cambridge Plastic Surgeon
5.0 out of 5 stars 8 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.