Do I need a lift now with my UHP, 650cc, Mentor silicone implant?

Although I do 99.99% of my augmentation/mastopexy surgeries as a single stage, the size of your desired implants would put a strain on the healing of your tissues if a simultaneous lift was performed, leading to less than ideal scaring and possibly lower nipple position. Therefore, doing the lift as a second operation would be to your benefit.  You should not consider subglandular placement of these oversized implants, you will be regretful later with high risk of palpability and rippling. Finally, you should realize that big implants have bigger and more frequent problems, some that might not be fixable. Thinking long term will likely make you less regretful 20 years from now. 

Hello and thank you for your question and sharing your photos. You do have significant asymmetry, ptosis (sagginess) and volume deflation. You would need a breast lift, at least on one side. Breast lift with implants, also known as mastopexy-augmentation, is a common procedure but requires experience on the part of the plastic surgeon. I would seek consultation with a board-certified plastic surgeon with extensive experience in performing breast surgery. Best,

Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  Based on your photographs and right breast asymmetry with ptosis, the best shape and contour could be achieved with an implant and a breast lift. A large part of your breast sits below the inframammary fold and 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.  

Best wishes and good luck.

Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

Your breasts are too low on the chest wall and asymmetrical in volume, shape and position.  Implants alone will not solve your problem.  Also, 650 cc implants weigh 1 ½ lbs each.  The implants will have to be centered underneath the nipple-areola complex which requires releasing the inframammary fold resulting in further descent and bottoming out.  Instead, I recommend a breast lift using 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.  Later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  8% fail within the first year and 30% fail within six years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Thanks for the photos.  The photos of patients you have put up are patients who are all implant and minimal breast tissue.  Also they did not get any lift and you would benefit from a lift.  The implants you are looking at will give you upper pole fullness whether you put them in front or behind the muscle, however, given all the complications associated with implants in front of the muscle, most of us will not put implants in front of the muscle for the benefit of the patient.You have some asymmetry and would definitely benefit from a lift to get you more symmetrical and with placement of implants.  You can certainly do both procedures at the same time.  Another option that I will throw out at you would be to have a breast reduction and remove as much of the breast tissue you have and then in 4 months later come back for implant placement.  This way you can get closer to the look you are trying to achive.Make certain you see a board certified plastic surgeon to discuss your surgical options.Hope that helps.

Dear princeton12986,
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 inframammaryline 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

Without the lift, you may not be even. the implant you are choosing will be large and heavy on your tissue and increase the risk of sagging. You might consider going down in size and getting the lift for better long term results.

A breast lift will reposition your nipple and your breast tissue higher onto your chest. You should expect at a minimum a vertical incision down the front of the breast below the nipple. You may also need an additional incision along your natural crease for greater lift. Implants can also be placed at the same time or at a separate surgery if you would specifically like more fullness or roundness on the top of your breast and a larger size. A breast lift alone will make your breasts slightly smaller since some skin and tissue will be removed to tighten the envelope and lift your breasts. Again if you are unsure, you can always have implants placed at a later time which will also allow you to make some adjustments to your breasts. Doing the procedures separately decreases your risk of needing additional touch up surgeries.  Hope this helps!!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Given the asymmetry in your nipple height, I would recommend a lift on the right side to enhance your result.  When a lift is done with the augmentation, it is not generally safe to put in extremely large implants.  The lift decreases the size of the skin envelope whereas the augmentation tries to enlarge it.  Those competing forces can cause issues (wound separation, compromise of blood supply to nipple).  You may need to go as large as is safe right now, then upsize in a year or so to get to your desired size.  I realize you would prefer a single operation, but for that large of an implant, I would not feel good about a one step approach.

Hi and welcome to our forum!From your photos, Your breasts are asymmetric with nipple areolar complexes at different altitudes, the distance from the top of the breast bone appears increased, and the distance from nipple to the fold at the bottom of the breasts is relatively normal on the left.  As there is no lateral view of the right breast, I am unable to ascertain the extent of sag. A lift is required to elevate the nipple- areolar complexes and conify the shape of both breasts.This will increase superior pole fullness as well. If your breasts are of different volume, differential fill breast augmentation will equalize them. I have never been a fan of ultra high profile implants except in unusual circumstances as in my opinion they look too artificial.  Visit a board certified plastic surgeon for in-person evaluation and discussion.Best wishes...