Donut Lift and Implant Choice - Trying to balance safety, shape, and scar minimization. Suggestions? (Photos)

Dear CO82girl,

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

Breast augmentation using ergonomically designed implants like Ergonomix placed above the muscle is increasingly recognized as the safest technique available today. Long-term studies clearly show significant advantages over textured implants, particularly in terms of reduced complications. Since textured implants typically require submuscular placement, unnecessary muscle trauma and extended recovery times can occur. Therefore, our recommendation is to use ergonomix implants in a subglandular (above-muscle) position.
Additionally, the innovative "Preserve Technique" has recently emerged as a superior option in breast augmentation procedures. Regarding breast lifting, the donut technique (periareolar lift) often falls short in achieving optimal three-dimensional reshaping. Instead, a short-scar inverted-T technique typically provides significantly better outcomes, enhancing breast shape and overall aesthetics.

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

Your thought process is logical but I think the main issue is you are are trying to make decisions you perhaps are not in the best position to make. Choosing an implant style and types of lift etc are very complicated decisions that one can't really enter into unless they are a plastic surgeon. So in these cases we have to rely on others to help us make the decision. It sounds as if you are not confident your surgeon can make the right decision so I would get an appointment with another plastic surgeon and review your thought process and come up with a plan with your surgeon and go with that plan.

I think you may be able to have a nice result without doing a lift.
Personally, I do not like the donut lift.
It has a bad tendency to stretch out the areolas and creating a wide scar.
Most surgeons don’t do the procedure well and many patients really aren’t great candidates for a donut lift.
In my opinion the doughnut lift should be avoided.
Because you would only need a slight lift, you would considered be a good candidate for a donut lift, but I still think it’s a bad procedure.
It’s quite possible you’ll have a nice outcome, but I’ve seen too many problems to recommend it.
There are a lot of variables to take in the consideration, including skin quality, areola size, etc., etc.When it comes to implant selection, each plastic surgeon will have their own way of guiding patients through the decision-making process.
I suggest you focus more on provider selection rather than trying to figure out these variables yourself.
Personally, I see absolutely no reason to use textured implants, but some providers like them.
I would stick to the basics which is size and profile.Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Some providers do this better than others.
Some plastic surgeons will have the patient make the final decision regarding implant selection.
Other plastic surgeons will make the decision based on input from the patient.
My personal preference is to work with before and after pictures to get a clear understanding of what the patient is hoping to achieve.
I either use my own before and after pictures or ask patients to bring in examples of previous patients who had very similar body and chest characteristics with ideal outcomes.
Once I have a good understanding of what the patient is hoping to achieve I bring those pictures with me to use as a reference during surgery.
During surgery, I use temporary breast implant sizers to determine what size and shape implant will give the desired outcome.
I typically have a full selection of implants available during surgery to choose from.
I take the final responsibility for the implant selection based on having a fairly good understanding of what the patient is hoping to achieve.I found that making the decision during surgery using a temporary sizers is the most accurate in obtaining the result the patient desires.
This does require for the surgeon to have an implant inventory or bring several implant sizes during surgery.
This is a potential inconvenience for the surgeon, but in my opinion is the better way to do this process.
Like I mentioned, each provider will have their own way of guiding a patient through the implant selection process.
In the end provider selection is the most important variable to give the desired outcome and minimize the chance for needing revision surgeries.
Revision surgery after breast augmentation is fairly common.
Adding a breast lift increases revision rates.
Finding the right provider is not at all easy or straightforward.
To find the best provider, I suggest patients schedule multiple in person consultations with plastic surgeons in your community who have lots of breast surgery experience.
Bring pictures of yourself to use as a reference during the consultation.
Do not rely on the memory of what your breast look like.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar body and breast characteristics.
An experienced provider should have no shortage of example examples to show you.
A lack of before, and after pictures should be a major red flag.
If a provider doesn’t have enough examples to show you what outcomes look like of previous patients with similar breast characteristics, they may not have enough experience.
You should ask each provider what their revision rate is, what the most common reason for revision surgery is and what their revision policy is.
There’s no correct number of consultations needed to find the best provider.
Generally speaking the more consultations a patient schedules the better they’ll be vetting providers. Having multiple consultations increases the chance of finding the best provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
Having only one consultation, eliminates the possibility of choosing a better provider.
Average providers deliver average results.
Exceptional providers, deliver exceptional results.
As with almost all plastic surgery procedures, the best strategy is to do it once and do it right.
The biggest and most challenging variable then becomes finding the right provider.
In general patients are not good at choosing plastic surgeons.
Finding the right provider is time-consuming and may involve financial expense.
Considering the impact of getting this procedure done correctly versus the need for multiple revisions, the investment in time is well worth it.
Good luck,
Mats Hagstrom MD