28, 5’5, 135lbs, c cup - consults for lift & implant completely different, can you help? (Photo)

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They then get to choose what looks right for them. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

You have heard two different approaches currently present in breast augmentation/lift. One is placement of implant underneath, the orher, on top of the muscle (your are candidate for both). Some surgeons, myself included, preffer placing implants underneath the muscle when performing breast lift simultaneously; blood sypply to the breast is better preserved. In the case of visible asymmetry, I am in favour of reduction of larger breast and augmentation with same size implants. When it comes to size (volume) of the implants, difference of 50 ml will not make any visible difference; it is only 10% of the implant volume and, very likely, 5% of total breast volume. I hope this may help you to make right decision and select right surgeon. Good luck.

The technique I recommend is 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 can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Hi, thank you for sharing your question. Both doctors should be able to achieve your desired goal. You are a good candidate for this procedure and you will need to discuss the pros and cons of both options with your surgeon.

Many surgeons don’t like doing lifts even when it’s obviously necessary. In your case it’s necessary. You’re better off doing nothing than getting implants only. Go to someone who has done a lot of lifts with implants. If you’re not willing to accept the scars don’t do anything

Dear etrab,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I always place implants behind the muscle for better upper breast fullness and support in women who need a lift. Placing the implant in front of the muscle requires that your stretched out tissue support more weight. I also recommend not going with a large and heavy implant for your stretched out tissue will not support this well over time. Smaller implants work better for women who need lifts. Over time, removing excess breast tissue and giving you the same size in both breasts may work better, especially if you have any weight gain over time. However, it does not have to be done and you may lose more sensation with breast tissue being removed. I would suggest looking at photos of women similar to you with both surgeons and see whose work you prefer.

Hi and welcome to our forum!
The lateral view photo you presented demonstrates moderate sag with the nipple at the level of the fold beneath the breast.
No two artists will pain a picture the same way...so it is with plastic surgery. Each plastic surgeon has their own individual preferences based upon their training and years of clinical experience.
You report size asymmetry...One surgeon recommends reducing the larger breast, the other recommends differential fill augmentation. Either procedure will improve symmetry. Your choice depends upon whether you are pleased with your present size. If yes, consider differential augmentation. If you wish size reduction, consider breast reduction.
The difference between 400 cc and 450 cc is 50 cc, slightly more than a shot glass (45 cc). There is no significant difference of opinion.
The subglandular / submuscular debate continues...Subglandular augmentation involves placing the implant under the breast and over the pectoralis muscle. As the muscle remains intact, there is less postoperative discomfort. Subglandular augmentation may increase the difficulty in interpretation of mammographic findings. However, newer techniques have resulted in more accurate interpretation.
There is an increased risk of capsular contracture with subglandular positioning. Subpectoral implants have a lower rate of capsular contracture. There is a greater change of implant "rippling" in patients with lax skin and small breasts with subglandular placement. Subglandular placement allows for cleavage accentuation by placing implants closer to midline as there is no overlying muscular restraint. Submuscular placement may cause an animation deformity associated with contraction of the overlying pectoralis muscle.
Consider a procedure with the surgeon with whom you feel the most comfortable.
Best wishes...