Happy with nipple current positioning. Do I need an uplift as well as an implant? (Photos)

Question

Hi all, I need some advice. I have been advised by one surgeon that I need an uplift. However, I don’t particularly want the scarring. I’m interested in hearing other people’s opinions. I am happy with the nipple position as it is not downwards facing. I would just like some fullness, especially around the top, but not super high profile. I wonder if a full profile w giv the effect as it would sit lower? I have no idea how this works so I could be completely wrong ! I was thinking a larger inplant for volume, possible 425cc. I used the mentor app as a guide but am unsure of these results would be completely unrealistic with only an implant.

Emre Guvercin, MD, FEBOPRAS · Answer

This is a very common and understandable question &mdash; and you’re right to be cautious about scars. That said, based on what you describe, a lift really is necessary to achieve the result you want.Even if your nipples are not downward-facing, breast droop is not defined only by nipple direction. When the breast tissue itself has descended and the upper pole is empty, an implant alone cannot reposition that tissue.Why a larger implant won’t replace a liftUsing a larger implant (e.g. 425 cc) or a different profile does not create lift. Instead, it usually:Adds weightSits low in the existing breast envelopeMakes the lower pole heavierCan actually worsen sagging over timeA “full” or higher profile implant does not sit lower to simulate lift &mdash; it simply projects more forward. It cannot move breast tissue or tighten skin.This is why many patients who skip a needed lift end up with:Upper fullness only when wearing a braA “bottom-heavy” look without supportThe feeling that something is still “off” despite having implantsAbout scarsModern mastopexy techniques are far more refined than many patients imagine. In many cases, scarring can be limited and strategically placed, and the trade-off is a much better shape with a smaller implant, rather than relying on excessive volume.What gives the most natural resultIf your goal is:Upper-pole fullnessA natural lookAvoiding an overly high or “done” appearanceThen the most predictable solution is:A conservative lift to reposition your own tissueCombined with a moderate-profile implant, rather than a very large one

Moises Salama, MD · Answer

Thanks for your question. It is difficult to provide you with a proper recommendation with these pictures. I would recommend schedule a consult for a proper evaluation. Please be sure to always consult with a board certified plastic surgeon. Take care, Dr. Salama, Board Certified Plastic Surgeon.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Do I need a breast lift? You might not need one.  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

Donovan Rosas, MD · Answer

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.
With regards to your specific question, as long as you are amenable to a less than optimal result, beginning with an augmentation is not unreasonable. This will allow you to evaluate your result without the added scarring.
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.

Daniel Barrett, MD · Answer

Dear lollaa669,

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

John LoMonaco, MD, FACS · Answer

As best I can tell, your nipple position is OK, but you might have a long breast fold.  If that's the case, then adding an implant will tend to make that fold even longer and the implants sit lower.  Most women prefer upper pole fullness, not lower.

Accepting the breast scars in a lift is fine, but in my experience you need to be REALLY unhappy with the sagging of your breasts to make it worthwhile.

Your doc should discuss a "dual plane technique" to help lift your breast a bit from the inside, without doing a  formal lift.  Best wishes, and keep us posted.

Camille Cash, MD · Answer

Implants don't do much to lift the position of the nipple. If a lift is needed and not performed there is a risk that the implant will sit higher on the chest wall and the breast tissue will fall in front of it (Snoopy deformity/waterfall deformity) or that the implants sit low and there is a lack of fullness at the top.  A general rule of thumb is that when standing naturally with arms at your sides if the nipple position is above the breast fold then a lift is not needed.  If it is below then a lift may be recommended. The best recommendation is to visit with a few board certified plastic surgeons near you for consultations.  The expert opinions should help you decide what is best for you based on your anatomy and surgical goals.

Happy with nipple current positioning. Do I need an uplift as well as an implant? (Photos)

Answers (7)

More Breast Lift with Implants Questions

Uplift with under the muscle 265cc implants. Crossfit concern - should I reconsider the implants?

What is the issue with my breast implants? How can this be fixed? (Photo)

Small Implants - How can I avoid paying anymore consultation fees and find a doctor that supports my aesthetic goal?

4’11", 110 lbs, 31, breastfed 2 children. I want to get a lift with implants. Size, profile & placement suggestions? (Photos)

Do I Need a Lift or Just Implants? 3-Kid Mom with Vitiligo Scars (Photos)

Did my lift fail? Will it happen again? Is removing the excess skin an adequate solution? (Photos)

WE SEND PRETTY
EMAILS