Grade 1 ptosis. Do I need a lift? Saline or silicone? (Photo)

Question

I am very interested in getting a breast augmentation, however I’m afraid I may also need a breast lift. I have done a little research and come to the conclusion that I am a grade 1 ptosis. Although i have spoken to a few surgeons (3) and none said I would need a lift, I am still a little skeptical because I am really hoping for that perfect, dramatic, no bra, breast look. I also have come to believe saline implants would give me this look more than silicone could. Any help would be appreciated!

Robert Kearney, MD, FACS · Answer

If you like the appearance of your breasts then you can by with out a lift.  If you want your nipple higher on your breast you would benefit from a lift.  There is a new device called Bodytite which could elevate your nipple areaolar complex without putting a scar on your breast.  You would be a good candidate for that device. In terms of saline or silicone, the look is the same.  A silicone implant may last longer which maybe a reason to put in silicone.

Ronald J. Edelson, MD · Answer

I think you are borderline as far as needing a lift.  If you want a lift I would perform the lollipop type lift with an implant.  Saline or silicone is up to you.  Not all surgeons are crazy about performing lifts because they are more involved than a simple breast augmentation while others are quite experienced with the lift.

Gerald Minniti, MD, FACS · Answer

Hello,
You are mistaken about your degree of ptosis, and no, this is not a 'bordeline' case as described by a young colleague. You will need a breast lift if you want aesthetically pleasing breasts. You are also mistaken that the type of implant will have an impact on your outcome. Go visit a few ABPS certified/ASAPS member surgeons who specialize in all forms of cosmetic breast surgery, not just implants.  Best of luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs and breast asymmetry, the best shape and contour could be achieved with an implant
and a breast lift.  Without a lift in addition to the implant, this will not have a natural
shape.  A breast lift with an implant can result in a very nice shape if
good technique is used.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Urmen Desai, MD, MPH, FACS · Answer

You are on the boarder of needing a lift or not.  If you are OK with having your breast footprint slightly low on your torso at the expense on now having much scarring, then just an implant is fine.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear esa05,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

Johnson C. Lee, MD · Answer

Thank you for your photos. It is hard to tell since your photos are not in a standard position, but it appears that you mayneed a breast lift. You can avoid a breast lift now if you are looking to have larger implants and/or place them above the muscles, however this can increase your risk of complications or need for a lift and revision surgery in the future as your skin stretches and ages.If you would prefer to use smaller implants and want a higher, round perky look, then you may want a lift now. It is best to discuss this with your plastic surgeon so he or she can show you what to expect with each option. Hope this helps!Johnson C. Lee, MD
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

Thanks for sharing your question. I can appreciate your concern.
  Let's start by saying that there is not such a thing as a perfect breast. No body have perfectly symmetric breast to start with. I believe in improving and trying to obtain shapes as close as possible to ideal. However, you need to understand that perfect does not exist. 
You seem to have a grade 1 ptosis based on your pictures, however, physical examination is needed for a best assessment. I do think that you may need a lift, depending on the size of your implant. 
Finally, make sure that you have a consultation with a board certified plastic surgeon.
  
Wishing you the best in your journey
IMPORTANT DISCLAIMER: It is difficult to say what is exactly happening with your case without a physical examination, testing or having done your surgery. It is imperative that you have a thorough examination by a board-certified surgeon. Only then, you may weight better the options to fix your current concerns.

Milind K. Ambe, MD · Answer

Thank you for your question and photos.  If you want to have a more augmented look with lots of fullness at the top then I would definitely recommend a lift with saline, high profile implants.  Without a lift you would get a more natural look but the breasts would sit lower for sure. Best of luck to you

Mehdi K. Mazaheri, MD · Answer

Thank you for your question and photos. In one of those pictures you look like you may be a grade 2 in fact. I’m kind of surprised that none of the plastic surgeons mentioned a lift. I think you are borderline, it really depends on the profile of implant you chose. I think with a high or ultra high profile implant you are less likely to need a lift. In regards to saline vs silicone it depends on the look you are trying to achieve. Silicone implant will give you a more natural looking and feeling breasts. I hope that helps. Good luck. DrMaz

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