I was wondering if I need a lift with breast augmentation? It is more then I wanted to spend. I was hoping just for an augmentation. Also, they want me to do over the muscle and another says I can do under. Please give me some insight.
Answer: Bellesoma Method You are a poor candidate for breast augmentation. You have a large skin envelope, your breasts are widely separated and you have no cleavage. You would benefit from a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired. Best Wishes, Gary Horndeski, M.D.
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Answer: Bellesoma Method You are a poor candidate for breast augmentation. You have a large skin envelope, your breasts are widely separated and you have no cleavage. You would benefit from a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired. Best Wishes, Gary Horndeski, M.D.
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July 8, 2025
Answer: Breast enhancement Thank you for your question. I have been in practice for over 30 years and breast surgery and revision breast surgery is a large portion of my practice. Unfortunately, when implants are placed on top of the muscle, the skin will just stretch without anything between the implant and the skin envelope. I have a whole gallery of problems associated with implants on top of the muscle. The good news is that you can have attractive breasts. You just need to have the implants placed under the muscle and a breast lift. Breast lifting is an art form that many plastic surgeons have not mastered. You should be able to have a beautiful result. Best wishes to you.
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July 8, 2025
Answer: Breast enhancement Thank you for your question. I have been in practice for over 30 years and breast surgery and revision breast surgery is a large portion of my practice. Unfortunately, when implants are placed on top of the muscle, the skin will just stretch without anything between the implant and the skin envelope. I have a whole gallery of problems associated with implants on top of the muscle. The good news is that you can have attractive breasts. You just need to have the implants placed under the muscle and a breast lift. Breast lifting is an art form that many plastic surgeons have not mastered. You should be able to have a beautiful result. Best wishes to you.
Helpful
July 8, 2025
Answer: Breast augmentation with lift A lift with augmentation would give best results. Implants would be under the muscle. Unfortunately, in my experience, Implants only, even above muscle, will still leave lower poles very low. Further consultations and discussions with your/plastic surgeons is recommended until you are comfortable.
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July 8, 2025
Answer: Breast augmentation with lift A lift with augmentation would give best results. Implants would be under the muscle. Unfortunately, in my experience, Implants only, even above muscle, will still leave lower poles very low. Further consultations and discussions with your/plastic surgeons is recommended until you are comfortable.
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July 8, 2025
Answer: Over vs. Under, Aug vs. Pexy Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both. There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision. A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred. While many surgeons recommend submuscular placement there are distinct differences to each approach. Subglandular Augmentation (“overs”): • Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster when compared to subpectoral augmentation. • Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection). • Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space. • Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling. Subpectoral Augmentation (“unders”): • Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients. • Subpectoral implants have a lower rate of capsular contracture. • Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion. • The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle. Based on your photos, you are a reasonable candidate for dual plane augmentation. It is difficult to assess the need for a lift without an exam. You appear to be a borderline candidate. It is possible to stage the 2 procedures. There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.
Helpful
July 8, 2025
Answer: Over vs. Under, Aug vs. Pexy Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both. There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision. A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred. While many surgeons recommend submuscular placement there are distinct differences to each approach. Subglandular Augmentation (“overs”): • Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster when compared to subpectoral augmentation. • Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection). • Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space. • Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling. Subpectoral Augmentation (“unders”): • Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients. • Subpectoral implants have a lower rate of capsular contracture. • Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion. • The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle. Based on your photos, you are a reasonable candidate for dual plane augmentation. It is difficult to assess the need for a lift without an exam. You appear to be a borderline candidate. It is possible to stage the 2 procedures. There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.
Helpful