135lbs, 5ft. To fix asymmetry and improve fullness, can I pass with just implants or is a lift necessary? (Photo)

Dear a7698j,


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

Thank you for your question. Whether you need a lift depends on nipple position and skin quality: if your nipples sit at or above the inframammary fold and point forward, you can usually achieve fuller, more even breasts with implants alone. In that case, keep sizes modest to reduce future sag. If your nipples are below the fold, a lift ± implant is the predictable solution, as an implant alone risks a “bottoming-out” deformity. You should have an in-person examination with a board-certified surgeon to measure nipple-to-fold distance, base width, and skin elasticity, and to align the plan with your goals and future pregnancy plans.

It depends on the location of your nipples in relation to your breast fold. If they are at or below the fold, a lift is recommended. A side photo would be helpful, however based on the front photo you’ve provided, a lift may be recommended (particularly on the right breast in the photo).

Thank you for your question. You have breast asymmetry, with the right breast larger than the left. In many cases like yours, breast implants alone can improve fullness and create better balance especially if the nipples are at or above the breast fold and there’s no significant sagging. However, the final decision depends on your examination. Your surgeon will assess the nipple position relative to the breast fold, skin elasticity, and the degree of asymmetry. If your nipple position is good, slightly different-sized implants can correct the volume difference. If there’s noticeable droop on one side, a lift may be recommended, either during the same procedure or later, to achieve the most symmetrical result.

With the information provided usually a patient would most likely need a lift, but in your case, perhaps only using different size implants will help achieve the symmetry that you’re looking for need of a lift. It seems that it would hold up an implant well, however, only touching the condition of the skin will help determine and if anything most likely only a periareolar lift may be needed. Also, since the pictures are taken with your arms extended slightly lifts them so we can’t really see how they would naturally fall, but again you would most likely not need it! I do believe you will have an amazing outcome!

Thank you for your photos. Your arms are up in your photos and may have artificially elevated your breasts. You have asymmetry, with your right breast larger than your left. To supply the best advice, first dimensional measurements need to be done of your breast to determine the width of your breast and the distance from your nipple to the fold underneath your breast under full stretch. These measurements will help determine the size implant that will fit you the best. You would need an asymmetrical augmentation to balance your present asymmetry. As a rule, if your nipples are below the level of the fold underneath your breast, a lift is needed to give the optimal result. You should discuss this in detail with your plastic surgeon and weigh the benefits and downsides of a lift done concomitantly with a breast augmentation.

Thanks for your question.From your description and the photo, it appears you have signs of mild tuberous breast anatomy, which is more common than many people realize — especially in patients who’ve experienced weight fluctuations during adolescence.
This typically includes:
Lower pole underdevelopmentAsymmetry between the breastsWider areolas or conical shapeNow to your main question:
Can you fix asymmetry and fullness without a lift?Yes — in selected cases like yours, a lift may not be necessary. Instead, the combination of:Anatomically shaped implants (like Ergonomix or similar) to gently expand and round out the lower poleAnd targeted fat grafting to smooth asymmetry and soften contours…can give very natural, balanced results — without visible lift scars.The key is to reshape and support the lower pole from within, rather than lifting skin from the outside.

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos alone, nipple position appears preserved which obviates the need for a lift. You are a reasonable augmentation candidate and with careful implant selection should get a very nice result.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Thank you for your question. There appears to be under-development of the left breast in your photo, with a little constriction along the IMF. Implants can correct this asymmetry, but depending on the results you are looking for, may require a secondary procedure in the future. At the least, the smaller breast will need a larger implant to lower your breast fold and widen it at the same time, if the tissue is soft enough. A thorough discussion with your surgeon will help outline the surgical plan and if your visions align. Best of luck!