I'm a 34DD and I'm wanting to get a breast lift with implants, not sure what type? (Photo)

Question

What size and type of implant will give me the best results for a natural look?

Sheila S. Nazarian, MD · Answer

Based solely on your photo, you look as if you would benefit from a breast lift or a breast reduction if you are looking to also reduce volume. My best advise would be to schedule a consultation with a board certified plastic surgeon in your area (link below) who can assess you in person and discuss the ideal options for your desired results. Best, Dr. Nazarian

Larry S. Nichter, MD, MS, FACS · Answer

It is very difficult to determine the exact size and shape implant you will require as well as the best lift technique to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below:

Tania Medina de Garcia, MD · Answer

Hello dear, thanks  for your question and provided information as well... The breasts may lose their elasticity and firmness
which can be caused by different factors such as pregnancy, massive weight
loss, lactation and aging. To reaffirm the breasts and restore the natural look
your surgeon can perform a mastopexy or breast lift. I recommend you to get a small size implant of soft cohesive silicone type, like gummy bear, I"m recommending you a small size because you already have breast tissue, your other option is having a reduction, with a lift... Think about it with your doctor

James E. Hardy, MD · Answer

Hi and thanks for the question and photos. The best way to answer this question is to have an examination by an experienced board certified plastic surgeon. There are multiple types of implants available and the exact implant that is best for you will depend on the exact look that you want and the dimensions of your chest. Best of luck with your procedure...

Tom J. Pousti, MD · Answer

Thank you for the question and picture. Your pictures clearly demonstrate significant breast ptosis. As you state, you will benefit from breast augmentation/lifting surgery.
You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.  Some general thoughts may be helpful to you as you learn more:
Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.

Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate; obviously, the need for additional surgery, time off work/life considerations, and additional expenses our “factors” that should be considered before undergoing the initial operation.

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.

The analogy I use in my practice is that of a thinned out balloon, being expanded with additional air, while at the same time removing some of the balloons rubber surface. I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.

Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery.I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.

Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc). 
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. 
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural, proportionate look” or "D or DD cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this, and the attached link (dedicated to breast augmentation/lifting surgery concerns) helps. Best wishes.

Mark T. Boschert, MD · Answer

It really depends on what you mean by a natural look. You said you would like to have a lift and therefore I think you probably mean you would like to have more volume in the top part of your breast. So, therefore, I think you would do well with a round  Inspira type implant that has a high fill ratio. The best way to determine this is see a board-certified plastic surgeon in your area and we can take you through a sizing process to figure out exactly what size and shape will give you the results you're going for.Good luck!

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photo but ideally an examination with measurements and sizing with implants in a bra would be critically helpful.  So see some experts in the area, look at photos, compare fees and find your surgeon.Dr. Corbin

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Dear Ms. AzzedOut2016,Thank you for your questions and photos.My responses are the following:I. SIZE1)size of breasts is a personal choice. 2)using the formula 1oz. = 30cc ....take 8 and 1/3 oz of rice = 250 cc or 10 oz. = 300 cc and place in a nylon stocking to create your own "sizers". Then place in a full bodied non padded bra and try on some form fitting clothes.Caveat: The bigger you go the faster you will potentially again sag.II. SHAPE1)the reason your breast hang/sag is that your current "skin bra"is larger than your breast tissue.2)there are three main types of breast lifting proceduresa) periareolar (doughnut scar)b)vertical (lollipop scar) a combination of both a & bc)inverted t (anchor scar) a combination of a,b & cBased on the limited photos of you most likely will need option 2-c (the anchor scar mastopexy) to achieve the upper pole fullness you desire.3)implant selection/profile of implant:a)for the same volume the higher the profile the narrower the base width.and thus the rounder the implant with the higher projection.b)there are slight difference in projection between a moderate to high profile implant. However the ultra high profile breast implant is definitely the "roundest"implant available. c)ideally the base width of the breast should equal the base width of the implant. Would need your breast width measurements to pick the best implant, thus I personally chose the profile based on the patients chest measurements (a high profile on a wide chest may not result in the cleavage desired and conversely a low profile on a narrow chest may result in implant in the outer chest/arm area)d) on occasion to achieve the "round look" I will select a normal saline filled breast implant and overfill to achieve a more rounder appearance. However, the breasts may feel more firm.CLEAVAGEIs mostly determined by your anatomy.It can be improved by:1) with accurate placement of the implants, if aggressive surgery to increase cleavage a condition called Synmastia could occur (uni breast or breast loaf deformity)2) post operative massage.MODEL PHOTOSSelect several nude photos of your ideal breasts and then schedule several consultative appointments with experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally a members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

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