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)

Thank you for your question. Based on your concerns and review of your photos I believe you would get plenty of fullness with a breast lift alone. I think this would be the best and safest first step. I suspect regardless of the procedure you will need some support with an underwire bra, but this is just a guess. Remember, an implant can always be placed at a later stage but I would not necessarily recommend this initially based on your photographs. Good luck!

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

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

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