I am currently a 34c/32d with some sagging. My surgeon suggested a periareolar lift with subglandular placement (Photo)

Thank you for the question. There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.    

I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes). The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. 

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  that can be seen with breast implants placed in the sub muscular position.   

The Benelli breast lift can be effective for patients who require minimal breast lifting.  The Benelli breast lift  Is not a "powerful" breast lift when it comes to lifting breasts that demonstrate significant breast ptosis (sagging).   As you have heard, this type of breast lift can have the effect of a flattened breast profile.

 Most patients who present with significant breast ptosis would prefer to have an optimized long-term contour and accept the trade off additional scars.   Although difficult to understand, a full mastopexy often results in better scarring compared to a Benelli breast lift where all the tension of the breast lift is placed on an incision around the areola only.

My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well. Working together you will come up with a good plan to achieve your goals. Best wishes. 


 

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a vertical or wise pattern breast lift.  I rarely
recommend a Bennelli or circumareaolar (donut) lift.  Over time, the
areola tends to enlarge with a thickened scar.  The other even worse
problem with a circumareaolar lift is that it flattens out the shape
of the anterior breast over time.  A vertical or wise pattern lift with an
implant can result in a very nice shape if good technique is
used.  There are several
advantages and disadvantages to over vs under the muscle.  Under the
muscle has the advantage of lower capsular contracture rates, less risk
of rippling, and better visualization with future mammograms.  Most
patients say that under the muscle also has a more natural look and
feel.    The size 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

Hello,
Based on current knowledge of breast implant complications, we know that exposure to bacteria is a prominent cause of capsular contracture, the most common complication. Use of periareolar incisions and placement over the muscle puts the implants at higher than necessary risk for exposure and subsequent contamination. Further, subglandular placement of implants leads to less durable positioning of the implant and the overlying breast tissue, relative to subpectoral placement. Periareolar lifts do not lift the breast, only the nipple and are only appropriate for small, deflated breasts with minimal ptosis. You would do best with a formal lift. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Best of luck!