40, 4 kids, need lift & used to want implants - what's my best option? (Photos)

Question

I'm so sad with how saggy my breasts are. I'm 40 with 4 kids and am so tired of crying when shopping for a bra or swimsuit. My boobs fall out the middle of everything! I know I need a lift, and I used to want implants but am now worried about health risks. I want them to be perky and big but look natural. Any advice? What's the best option for me?

Casey Anderson, MD, FACS · Answer

If you are worried about health risk of implants, they may not be a good idea for you. The lift can definitely get things a bit more youthful in appearance.

Gary M. Horndeski, MD · Answer

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

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

There is no evidence yet to suggest that breast implants cause systemic illness. BII is a non-entity that is failing to survive even initial evaluation via prospective randomized trials. Breast implants are the most studied medical devices and they have a clean bill of health. Get your breast lift without implants if you want; the results may please you. If not, you haven't burned a bridge and can still get implants.

Ronald J. Edelson, MD · Answer

Get the lift only. It looks like you have enough breast tissue and don't need an implant. If you want one can be added later.

Daniel Barrett, MD · Answer

Dear Shwan2b4,
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

Gregory Lakin, MD · Answer

I think a breast lift alone would give you good results and look natural. You would have to request to your surgeon that they remove only skin during the lift to maintain as much volume as possible to provide you an auto augmentation. If you wanted additional fullness along the top of your breasts to make them look even rounder and perkier then you would need some implants. Both saline and silicone implants are safe. I usually recommend saline to save a little on expense for cases like you were there a sufficient breast tissue and muscle overlying the implant so that you do not feel the difference between saline or silicone. Good luck!

Jules Feledy, Jr., MD · Answer

From your photo and the history of 4 children, I believe that you would get the best result with an augmentation (of the volume) and a mastopexy (breast lift) including areolar and nipple reduction. Your photo shows that you have large pendulous breasts and are missing volume especially upper pole volume. The breasts have laxity. It is possible that a breast lift could be performed without adding an implant but you would have smaller breasts. It is also possible that fat grafting from the abdomen to the breasts could be performed. But if you wish for fuller, perkier breasts, realistically an implant is required for adding volume. I believe that you would get the best result with the following: at surgery, an implant is placed first. The size of the implant would be based upon your chest and body measurements, and then modified by your preferences- such as breasts that are slightly larger or slightly more moderate. Then the breast lift is performed. The excess skin would need to be reduced and tailored so the nipple-areola is centered over the implant. The areolae would be made smaller. A nipple reduction would complete the procedure and bring the breasts into a fuller and more youthful shape. Lastly, I would mention that breast implants are safe. We use smooth round silicone implants more than any other implant. There are risks and you should be aware of these. I have added a link to the FDA. Thank you. Respectfully, Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

Connie Hiers, MD, FACS · Answer

If you are happy with your size, then get a lift. If you want more fullness, add implants. Please do not go too large with implants or you will sag again from the weight.

Douglas McGeorge, FRCS(Plast) · Answer

You have a degree of droop which would require treatment before an increase in volume.
I would suggest seeking an opinion from someone experienced in breast surgery.
If in the UK, see a member of the British Association of Aesthetic Plastic Surgeons.

Darryl J. Blinski, MD · Answer

Agrre with you wants. I recommend full lift with liposuction and fat transfer to breasts. Fees in the $8,000 ranges. Seek in person or virtual consultations with boarded PSs.