Are my only options a lift with implants or implants over the muscle? (Photo)

An alternative is dual plane which is upper implant user the muscle and lower not.

In my experience, this combines advantages of under the muscle for shielding implant and allow lower pole expansion which may avoid a formal breast lift.

Breasts tend to stay low and natural looking.

Further discussion with your/a plastic surgeon is recommended to confirm if you are a good candidate.

Hi from Istanbul, thanks for your question. For this type of sagging, I usually recommend placing the implants over the muscle, as placing them under the muscle would definitely lead to a waterfall deformity. Adding a slight lift can help you achieve the breast appearance you're dreaming of. Hope this helps!

Because your nipples appear to be located below your breast fold, a lift would be recommended. The implants can then be placed above or below your muscle (whatever is recommended by your surgeon). A lift and augmentation would most likely give you the more obviously augmented look.

Thank you for your question and photos. Your pictures show loss of upper pole volume, and very mild ptosis. Both nipple/areolar complexes are at the level of your inframammary crease and point directly forward. I pre-pectoral or submuscular implant can be placed. This will give you a more youthful appearance, and improved shape and projection. In my opinion, a lift is not required.

Your nipples are a bit low but not so low that you require a lift. You have more deflation than true sagging. If you have a properly done dual plane augmentation, I think you will have a very nice result without the scar or cost of a lift. You also have the advantage of a more natural look and lower complication rate by having most of your implant covered by muscle. You do have mild asymmetry with your left breast [or right if photo in mirror] has a slightly lower nipple and slightly higher breast fold. Neither of these will stop you from having a very nice result. Good luck.

Dear Stellar0ne,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Depending on the size of the implant, a proper subpectoral placement with a type three dual plane dissection should give you a pleasing result without a lift. I agree, over the muscle in you would not be a good choice aesthetically and also increases your risk of capsular contracture. A third alternative is very similar to over the muscle, and is known as subfacial placement. Once again, it does not enjoy the benefit of tissue coverage compared to subpectoral, and data has not been convincing to declare as low a capsular contracture rate as subpectoral placement.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size implants. 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 is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Implants over the muscle would only make your situation worse. If you want bigger breasts then you need implants and I recommend behind the muscle. There are a couple of ways of doing this. One way being through a circumareola approach. Using the excess skin above your areola to lift your breasts higher and more medial and at the same time place the implants. The other way would be a breast lift using The Bellesoma Method. The breast tissue is reshaped 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.

You have sufficient soft tissue in your breasts, placing high-profile round implants over the muscle should provide a satisfying outcome. Using under-the-muscle plane insertion has specific problems that come with it hence under-the-muscle plane is not a go-to solution always. We can further discuss and tailor the specifics during our next consultation to ensure your desired results are achieved comfortably.
Dr. Safa Manav