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

Question

I am currently a 34C/32d with some sagging. My surgeon reccomended a periareolar lift with subglandular placement of silicone implants. Her rationale is because I have a lot of breast tissue already and it will camouflage Impant. She also felt that my breast tissue could sag below the implant if I go submuscular. Another surgeon an anchor lift with sub muscular placement. I would like some advice on what the best course of action would be

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.  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

Gerald Minniti, MD, FACS · Answer

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!

Paul Banwell, BSc, FRCS(Plast) · Answer

Thank you for your enquiryThis is a difficult one to answer without seeing you in person and discussing the nuances of decision making. Whilst it may not be helpful, there is no right answer here and both options suggested are perfectly acceptable treatments. It would also be possible to use an anatomical implant in isolation reserving a mastopexy for the future if you were not happy with nipple position down the line.The bottom line is that you need to feel comfortable with your surgeon and ask lots of questions to make sure you understand the process and to enable expectations to be relaisedGood luck!

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. The standard for your case would be a submuscular implant with a small lift. You could be a candidate for a subglandular implant but this would take an exam to make sure. Have several consultations with board certified (ABPS) plastic surgeons in your area and choose the surgeon who you think will deliver the results you want.Good luck!

Daniel Barrett, MD · Answer

Dear Uumai3eyal,I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jon Kurkjian, MD · Answer

Thank you for your question and photos
There are several variables to be considered when answering this question. It is always difficult to make a diagnosis based on photos alone, however, an augmentation with a smooth round silicone implant and a breast lift will acheive great results. When you meet with a board certified plastic surgeon, they will perform a set of measurements that will help determine what size of implants will fit your body and if a lift is needed.  I hope this is helpful

Curtis Wong, MD · Answer

is a misnomer as the dual plane partial submuscular technique can provide the same projection of the lower pole and you have the benefits of being under the muscle, primarily the diminished risk for contractures.  Yes, you will have some degree of animation but that is the tradeoff.  As for a lift, why not just place your implants first and then decide later if you need a lift?  That would also give you the opportunity to determine what kind of lift is best if you decide you need one.  Anchor lift at this stage???  No way in my practice and the scars are permanent and again, you can easily do small lifts in the office.  Lifts bring scarring, more costs, and a lot of risks so when in the gray zone, its always best to go with the augmentation first and then decide later.  In this scenario, avoid lowering your fold and use the ideal nipple position to determine where to place your implants.

Tom J. Pousti, MD · Answer

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.

Tiffany McCormack, MD · Answer

I have to wholeheartedly agree with Dr. Rand and Dr. Barrett.  I do a lot of revision cases on subglandular augs with periareolar lifts that have bottomed out, developed capsular contractures, widened areolas with heavy scars or just simply sit low like rocks in socks.  I personally recommend going under the muscle and shaping your tissue around that with a lift.  It does mean more scars but they typically heal very well and the new breast shape is well worth it unless you are seeking a lower, more pendulous look.  Good luck with your decision-

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 with augmentation such as 
silicone implants, you will get very nice results, contact a board 
certified plastic surgeon, I recommend you soft cohesive silicone 
implants about 350 cc's you will look pretty and they will be perky.
 
 Patients who goes to a consultation for drooping breasts (ptosis) or 
volume loss after pregnancy (pseudoptosis) almost always have one very 
important question. "Can my drooping be corrected with just implants or 
do I need a lift".
 
 Implants alone will correct drooping when:
  
Breast drooping is mild
The nipple is still near the center breast and does not      point downward
There is some visible skin beneath the nipple/areola      when looking at the breasts straight on.
The patient is okay with being at least a cup size      larger
A breast lift (with or without an implant) is better when:
  
Breast drooping is moderate or severe
The nipple is at the bottom of the breast or points      downward
There is no visible skin under the nipple/areola when      looking at the breasts straight on.
The patient is already a C or D cup breast size and      doesn't want to be larger
The areola is too large and the patient wants it reduced
I also show the patient photographs of a spectrum of breast
 scar present after a breast lift in order to check their tolerance for 
this scar. Most patients are surprised how little the scar shows and are
 okay with proceeding. If the patient really needs a breast lift, but is
 concerned about the scars, I will suggest they wait on surgery. In time
 the breast appearance problems will usually outweigh their concern 
about the scars.
 
 I use implants in combination with a lift when:
  
The patient wants to be larger in addition to being      less droopy
The patient desires to maintain projection and      roundness of the breast mound
I recommend to see a board certified plastic surgeon for a personal evaluation and discuss your concerns and your goals. 
  
 
  
Hope this is helpful. Good Luck.

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

Answers (14)

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