I really want them to be firm and not flattened when I wear things. Should I get a breast lift with or without implants? (photo)

Hello and thank you for your question.
Based on your photos, you appear to be a good candidate for a full mastopexy (breast lift) which will put your nipples into the correct position, decrease the size of nipple/areola and allow excess skin to be taken away, giving you a more youthful, lifted and firmer looking breasts. Some people are a little apprehensive to the full breast lift due to the scars, but typically they do very well.
You may be happy with just a lift and no implants, but if you get the lift done first, then you haven't burned any bridges to move forward with the implants at another time.
I would make a consultation with a board certified plastic surgeon and talk with your surgeon about the exact look you desire. Good luck!
Best regards, Dr. Karanetz
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Rounder, firmer and not flat kind of all point toward an implant. Natural tissue always likes to take on a natural shape after surgery.

You will certainly benefit from a breast lift, and I would recommend a Galaflex internal bra rather than implants. The bra will support the weight of the breasts and help maintain upper pole fullness.

If you are already a DD then you do not need implants but do need a breast lift. 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.

Best Wishes,

Gary Horndeski, M.D.

Hello @JR7406 and thank you for your question. It really depends on what you want. If you wish to maintain the same volume then a breast lift with prostheses is the best option. But if you do not mind that much about volume, then the best course of action is a lift to reaccomodate the mammary tissue and the areola and nipple are lifted. The breast shape is improved either by reorganizing the breast or, if necessary, a prosthesis is placed to add volume depending on your goal look. Best wishes!

Projection is elusive with either a lift or reduction. You would be served well with a combination of lift and reduction, to reduce some of your own natural size, and also add an implant, which would ensure projection and avoid a flattened appearance.

Excellent question! I feel you need a breast reduction with a lift rather then a lift with implants. If your breast are lifted without a reduction they will still be big and heavy and therefore will sag sooner rather then later. Adding an implant to a breast reduction is a little counterproductive so I don’t feel it is a good idea, especially in your case because your breasts are already heavy DDs. So there is no point in adding more volume and weight. A breast reduction will actually get rid of the excess volume and weight!

Once the breast reduction/lift heals, implants can be an option to fill out the upper pole.

Best of luck!
Dr. Miguel Mota

You could just start with the lift. If you want more size or fullness after that you can always place implants at a second stage.

Dear JR7406,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Tha answer to your question is more complex than you might think. Large natural DD breasts even lifted will want to go south again. The heavier the breast the more south it will go. If you add an implant you will have more fulness on top but that natural breast will still want to go south because of its weight . With the size of your chest an implant that is tall enough to accomplish upper pole fullness will without question make you larger.

To get what you are looking for you might first have a generous breast reduction. Diminishing the heavy breast tissue that will want to descend, and then come back and get an implant. The implant will give more fulness up top and then restore the volume, but implants placed properly tend to defy gravity.

While I will commonly do some small reduction at the same time of a lift and implant a larger reduction should have the implant staged.

Most patients do not wnat to reduce just so that they can have an implant-- but I hope this concept makes sense to you.

Best wishes.