Scheduled for a BL/BA but Should I Look into a Reduction As Well? (photo)

I'm currently a 36 small C. I have full anchor BL and BA scheduled for June. However, I am worried that because I have so much natural breast tissue that my breasts will ultimately sag quickly once implants are inserted. Should I be concerned? I don't have a lot of extra skin. I do have stretch marks from sagging and weight gain and loss. But still have full breasts. I go for my pre-op appt next week and I am leaning toward a smaller 255 cc moderate profile silicone implant.

Doctor Answers 6


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If you are happy with your breast volume, then a lift with autoaugmentation may be all that you need. A breast lift will not decrease your volume significantly since a minimal amount of skin needs to be resected in your case.  You mainly need lifting and reshaping.  Discuss this option with your plastic surgeon.

Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

Scheduled for a BL/BA but Should I Look into a Reduction As Well?

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It really depends on the size you are expecting to achieve. But understand a full lift can not accommodate a large implant. Best to discuss with your surgeon in more detail . 

Breast lift or reduction

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You are a candidate for a lift and, if desired, an augment but not a reduction.  Lifting does remove some skin and gram weight from the breasts but a true reduction is for macromastia.  A patient with macromastia would need the opposite of implants!!  I agree with others that you may do well with the lift alone, without implants but this is a personal decision.

Reduction and lift are almost identical operations - with one key difference

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You ask a question which is actually very intelligent and I think very important in the planning of these operations.  They are always a "custom job," and each lady's breasts are always different than those of other ladies.  However, there are some general "rules of thumb" I personally think about for these cases.  First, a combined mastopexy and augmention is just about one of the most challenging operations that I think I do on breasts.  You are simultaneously adjusting just about every variable used in assessing breasts, and you are doing it bilaterally and trying to get symmetry at the end.  I do a lot of these operations, and each one is always a challenge that requires thought.  Breast lift and breast reduction are really the same operation, with the exception that in a reduction you typically remove varying amounts of breast tissue, and with a lift it is more skin and maybe small amounts of breast tissue.  I use this concept to my advantage especially when there is a) ptosis of the breasts and b) asymmetry.  Whenever I plan an operation in which I'm removing something from the breast, I am always more interested in what I am LEAVING behind as opposed to what I am REMOVING.  Thus, in my  planning I focus on getting the remaining parts of the skin and breast tissue even and trying to use as close to equal sized implants (assuming I'm using implants) as I can.  This may entail removing more tissue from one breast than the other.  In addition, as you have properly pointed out, leaving behind a lot of saggy, loose breast tissue may be counterproductive in the long run as you will get recurrent ptosis.  I often remove a significant amount of lax breast tissue during lifts (remember, the design of the procedure is essentially like that for a reduction), and then I replace any desired volume with that of a slightly larger implant which will be expected to hold its shape and position better over time than the saggy breast tissue I'm removing would.  I think your question is an excellent one, and it gets at the heart of the intellectual and artistic challenges that these operations present, and it's what makes them so rewarding for me.  Best of luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

Scheduled for a BL/BA but Should I Look into a Reduction As Well

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I would say no. If the volume of the breasts will contribute to sagging, the implant volume will be just as effective and actual breast tissue. If you are content with the current size, skip the implants. If you want to be larger, try on implants to help choose a good size for you. Taking out breast tissue and using implants makes no sense to me.

All the breast. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breast Reduction as well as Breast Lifting/Augmentation?

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Thank you for the question and pictures. The question you asked may be helpful to many patients who are seeking to undergo breast lifting at the time of breast augmentation surgery.

 One of the most important “keys to success” when it comes to breast surgery is clear communication between plastic surgeon and patient. If, for example, a patient has  aesthetic goal of “firm, round” breasts, sometimes this look is better achieved after reducing some of her own breast tissue. Doing so, will allow the underlying breast implant to be more visible. In other words, the more breast tissue a patient has, the less she will be able to see/feel the round/firm look/feel that a breast implant can help achieve.

 Furthermore, the more breast tissue that is reduced at the time of the procedure, the less potential for issues such as breast tissue “sagging” below a breast implant,  which I think is one of the concerns you may have at this point.  Achieving perfect “harmony” between breast implant and overlying breast tissue can be very challenging.  I think that the left breast tissue present,   the easier it may be to do so.

 Therefore, my best suggestion to you would be to spend additional time with your plastic surgeon communicating your goals clearly.  In my practice, I would ask that you communicate your goals with the help of goal pictures to help prevent sources of miscommunication such as the use of terms such as “natural” or the use of cup sizes which can be quite  confusing.

 Best wishes with your upcoming procedure.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.