More Sagging After Augmentation??? Do I need a Lift?

I have met with my PS and look forward to setting a date. I forgot to ask him 1 question, which I will do but wanted to put it out there for other professionals. I am 52, mother of 2 grown children, did not breast feed. Currently a size 36 small B and the PS thought silicone under the muscle at 350 or 375cc to make me a small D would compliment my figure. Since I am somewhat "saggy" will having just implants be large but still "saggy". Do I need a lift as well????? Hoping not but am open.

Doctor Answers 15

Candidates for breast lift

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Based on the photos you provided you look like a good candidate for a breast augmentation. You may benefit from a limited lift to improve the asymmetry of your breasts. This involves implants and an incision around the areola or a vertical mastopexy. Communicate your overall goals with your surgeon to ensure the best results possible.

 On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a certified physician is always the best way to get the most accurate information.  


Too large an implant will make breast sag worse

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I do not believe that you need a lift.  You have a slight difference in breast volume and shape that your surgeon can adjust with a slightly smaller implant on the left and perhaps a circumareolar mastopexy on the left..

However, I would encourage you to think of sublglandular implants, which will sit better just under your breasts and not be too high, and I would encourage you to back off on implant volume--to 250 or so..  At 350-375, your breasts will react to the weight over years.  Your skin has already stretched.,  If you select larger implants, your tissues will stretch and thin over years and create a deformity that cannot be fixed.

Be very careful.  Good luck.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Breast augmentation with a lift

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Judging from your photos, it is possible that a periareolar mastopexy may be needed to postion your niplles properly after the implants are placed.  One of the ways I handle this in my own practice is to use a lower areolar margin incision for the augmentation and extend it to a periareolar incision if the lift is necessary.  This is all discussed with the patient before surgery.

Also, it is not really possible to accurately predict cup size before breast augmentation.  If your plastic surgeon lets you try implant sizers at your consultation, just find the size that will meet your goals.  Then the cup size becomes irrelevant.

Periareolar lift with implants

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I would also say that you could do an implant alone but for the best result with almost no scar and better symmetry, I would suggest a periareolar lift also.  There are lots of photos of these on my web site and you can barely see a scar.  Good luck.

Breast lift at the time of augmentation

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Dear Baystater,

In your first picture, your left arm is out to the side much more than the right, and this seems to accentuate the asymmetry you have.  In the third picture it still seems that your arms are not exactly out at the same level.  This is a good example of why it is difficult to give 100% accurate advice online, and why seeing and discussing these issues with your plastic surgeon is  the best thing to do.  Having said that, it does appear that the left side would need a lift of the nipple to correct the asymmetry of nipple  position that you appear to have.  I think, based on your pictures, that the right side could probably be left alone.  By all means discuss this in person with the doctor who is going to be doing the operation.  Good luck

More a question of your desire

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Your left breast looks elongated in the pictures and the right is more rounded.  Both show some degree of sagging, the left more than the right.  Much of this sagging, and some of the asymmetry can be corrected with breast augmentation alone.  However, this will likely lead to a more "mature" looking breast.  If you would like a more youthful looking breast with a lot of fullness in the upper pole, I would suggest that you strongly consider a lift at the same time.  You are going to have to decide because the trade off is more scars on your breast with the lift.  If you are uncertain, you could always go ahead with the augmentation and add the lift later if the first procedure falls short of your desires.

Augmentation Without Lift

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In your photo, it appears that your nipples are located above the inframammary fold which is the most important criteria for determining whether or nor you "need" a breast lift.  It is important that the implants are the proper size and are placed precisely, but I think you can get a nice result with an augmentation alone.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Augmentation and breast lift

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The photos suggest that 350/375 cc implants should be able to fill out the minor degree of 'sagging' that you have. There is also some minor asymmetry of your breasts - this will be difficult to correct without a small lift. If you do not mind the small difference between the nipple positions (after all no human being is perfectly symmetrical between the left half and the right half of their body) then just an augmentation should do fine.

Anindya Lahiri, FRCS (Plast)
Birmingham Plastic Surgeon

Augmentation will increase breast size but not improve the nipple placement.

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Augmentation will increase breast size but not improve the nipple placement.  A slight lift will help the nipples appear higher. 

Breast augmentation together with breast lift

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Your posted photos show a lot of skin stretmarks and asymmetry with the left nipple lower and further from the midline than the right  and the left areola larger than the right. It does not look like you need a lift perse but you will need a skin procedure to make the nipple areola complexes more symmetric. Just putting implants in may make the asymmetry greater. You also need to realize that you have a lot of stretchmarks on both breasts. These may become more visible after breast augmentation. They indicate that the skin has less elasticity than normal skin. This may affect the skin's ability to wrap around the implant. 

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.