Can I avoid a lift & achieve my goals? (Photos)

I had two consultations so far. My first choice said I would need a lift and he would not insert implants without it. My second choice said I can benifit from a lift but I may be satisfied with implants alone or I could stage the procedure getting implants first and seeing how I like it. My first question is does a lift actually lift the breast or does it just change the nipple position and size? Also my goal is to have fuller perky breast. Goal pics attached. Wanting 450-500cc HIGH PROFILE

Doctor Answers 12

Third opinion on whether a lift is needed...

From your photos, you need a lift (with reduction on her larger, droopier side so that you will have improved symmetry of the shape and size of your breasts, allowing you to use same sized implants rather than different sized ones.  If you really do not care about your nipples being more level, then you could just have an asymmetric augmentation as suggested by one of your consultants and then decide later if you really need that lift or not.

Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Implants without lift

A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved. The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies. Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Can I avoid a lift & achieve my goals?

Those all sound reasonable options, and if you go to five plastic surgeons, you will get six opinions. I think you maybe an excellent candidate for the Horndeski Method.

Mahmood Kara, MD
Toronto Plastic Surgeon
4.7 out of 5 stars 18 reviews

Can I avoid a lift & achieve my goals?

Given the wish pics you presented, I think that you cannot avoid having a lift. Seek a plastic surgeon that performs hundreds of these procedures, has great reviews and photos, and is an expert in this field.

Ron Hazani, MD, FACS
Beverly Hills General Surgeon
4.9 out of 5 stars 254 reviews

Can I avoid a lift & achieve my goals?

Thank you for the question. Given your asymmetry, and the excess tissue on your right side, you would benefit from adding a lift to your augmentation. 

Can I avoid a lift & achieve my goals?

Most obvious to me is the significant asymmetry in your breasts that placement of implants can hardly address. Right breast has significantly more skin as well as breast tissue volume than your left and without a full lift on that side the skin could not be made more symmetric.  Not dealing with this at the initial surgery will simply in my opinion exaggerate the asymmetry leading to potential dissatisfaction.
Good luck and spend some time reviewing your options carefully before making a final decision.
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 29 reviews

Can I avoid a lift & achieve my goals

Lifts can be done to different degrees. What I mean by that is  a small lift will appear to only relocate the nipple, while a larger lift will reposition and reshape your breast. I do not think you will get to your desired appearance without a lift and I would suggest something more than just a nipple relocation

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Breast lift surgery for breast aesthetics

In general terms, a breast lift reshapes the breast, removes sagging and excess breast tissue and skin, and moves the nipple and areolar complex into an ideal position. Its possible and fairly common to combine breast lift surgery with a breast implant.

Can I avoid a lift & achieve my goals?

If both breasts look like your smaller one, then yes you could get your goal look without a lift. But, with the dramatic asymmetry your photos indicate, a lift is necessary. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Can I avoid a lift & achieve my goals?

Implants alone do not adequately lift the breast when there is significant sagging, no matter the size or type of implant, and will not produce a good cosmetic result in a patient who also needs some variation of a lift.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person and be very realistic about your potential cosmetic result.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.