Can I avoid Benelli lift and have Breast Augmentation only? (photos)

I am perplexed! I had five consultation with board certified plastic surgeons and only one told me I need Benelli lift. I am 5', 120lb 43 years old female. I would like to avoid any scars of the breast tissues and wanted to have breast augmentation via transaxillary incision, I also wanted to have small implants in 200cc range to get more natural look for my height. The surgeon who suggested Benelli lift told me I cannot do small implants without a lift. Your input will be highly appreciated!

Doctor Answers 29

Can I Avoid a Lift?

So what I find quite perplexing, and curious, is that you saw five surgeons and only one of them recommended a lift, while almost every single surgeon who has answered your question on this forum has stated that you need a lift and more than just a Benelli type of lift. You also stated that you wanted your implant to be placed through a transaxillary incision with an implant in the 200 cc range. I am agreement with the others on this forum, that based on what we can see from photos, you will not achieve a pleasing breast appearance with an augmentation alone, and that you definitely need a lift and not just a Benelli lift.


So why is there such a huge discrepancy of opinion? It is apparent from your question that you are very adamant about not having any scars on your breast ( transaxillary incision) and likely you have firmly made that point with every surgeon you have seen. So these surgeons are responding to your demands by offering you just what you are asking for, despite the fact that it really is not the best choice for you. The one surgeon that did recommend a lift also compromised with a Benelli lift which is not a good option for most patients because it only minimally raises your nipple position while at the same it causes flattening of your breast. You do not need your breast to be flattened and you need to have your nipple position raised a good amount. I think a vertical or lollipop type of lift would be more appropriate.


I can only think two reasons why the surgeons you have seen have not recommended doing a lift. The first is that you have not consulted with Real Plastic Surgeons, i.e. surgeons who are actually certified by the American Board of Plastic Surgery. There is a big difference, but it can be very confusing to patients when they see someone who claims to be "board certified", and has a bunch of certificates on the wall. It seems as though they might be qualified, but if your training was really as an OB-Gyn, and then you decided to re-invent yourself as a "cosmetic surgeon", you simply cannot become a qualified expert in breast surgery by going to a weekend course and purchasing a new plaque for your wall. The second reason is that in highly competitive markets surgeons may feel compelled to do whatever it takes to meet a patients demands in order to get the case, despite whether what the patient wants is really what they need. Interestingly, the only surgeon on this forum who suggested you could do just an implant alone was also from Scottsdale.


Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Can I avoid Benelli lift and have Breast Augmentation only

an augmentation will leave you with nipple/ areola complexes that are pointing down. If you can live with that the the implant alone is an option.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Can I avoid Benelli lift and have Breast Augmentation only?

Obviously it is preferable to avoid excessive scarring if possible, but conversely there are no shortcuts to good results. You can do just the implant procedure but it is most likely the implants will sit much higher than your nipples accentuating the droopy look. Implants have to be centered behind the nipple to give an attractive look, but if the nipples are low, as we see in your photo, they have to be raised to a normal anatomic location and then the implants are centered behind them. But here is another thought if you are not in sync with those of us who feel a lift is important...you can always do the augment and if it does not have the desired appearance, a lift can easily be done later. The dual plane implant placement is the only technique that will possibly allow you to have implants without a lift as it will hold the implants lower. That technique is not well done via the armpit incisionThe Benelli procedure performed by an inexperienced surgeon often results in large areolas and wide scars. An appropriately done Benelli procedure by an experienced surgeon will have far better results . A lot for you to think about. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

To Lift or Not to Lift, That is the Question!

When the nipple and areola sit below the breast crease, in most cases, it will be difficult to achieve a youthful result with only implants.  This is because the nipple should ideally sit above your breast crease and the implant should be maintained in a youthful position.   If doctors are not recommending a lift, it is likely because they wish to place your implants lower on your chest to better center on the nipple.  This may lead to a "low" breast augmentation result which you may not be happy with.   I would seek additional consultation with well respected plastic surgeons in your area who specialize in breast surgery.  I would also ask to see photos of patients with your breast shape and position who have undergone the proposed procedures.  This is one way you can find the ideal doctor for you!    Best wishes.

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 32 reviews

The decision to undergo a lift is a personal decision

In cases like yours, I simply make an agreement with  my patient.  If she is firmly decided on a particular plan, as long as she has a realistic expectation of the likely outcome of that particular plan compared to others I might recommend, I will consider do the procedure she prefers, as long as it is safe and ethical to do so.  Just because we can do a particular kind of lift, and just because I myself might think that the aesthetic results of that lift would be "better" than without, my patient may not feel that way.  To be sure, there are some additional downsides to consider with lifting procedures, including scarring, greater chance of things like tissue loss, loss of sensation, capsule contracture, and the like.  So, I don't necessarily think that just because a lady meets the "classic criteria" for a lift, she HAS to have one.

Now, having said that, we have to discuss the brass tacks of what surgery can and can't do.  First of all, you are 43 years old, you likely have had a baby (or more than one!), maybe even breastfed them, and with those things come some intrinsic weakening and looseness of the tissues.  There is nothing we can do about this.  If this causes the nipples to be a bit low, the only way to reliably position them higher is with a lift.  If the breasts are deflated, breast implants alone can help fill them in a little bit and maybe raise the nipples a little bit too, but this won't be like a lift.  If you would be happy with that situation, then there is nothing that says you HAVE to raise your nipples.  Closely linked to this is the issue of the breast itself.  If the tissues are loose enough, they will sag, and they will hang lower and with less fullness, or "perkiness."  An implant alone may only serve to make them bigger.  They may be just bigger versions of low, saggy breasts.  If all you want is larger breasts, and you don't mind the possiblity that they may still be a bit low and loose after surgery, then you may be happy with just breast implants.   There are some ways that we can put the implants in from a technical standpoint which can help with this somewhat, but again, it is not like doing a lift.  That is why lifts were "invented."  You need to keep in mind also that the smaller the implant used, the less it will "fill up" the loose breast tissues, and the more saggy they will remain.  Thus, sometimes the addition of a lift, like a circumareolar, or "Benelli -type" lift, would help in that regard if we wanted a fuller, firmer, "perkier" looking breast.  In your case, you may fit into that category.  You probably won't get that full, perky lifted look with implants alone, especially 200 cc implants, and especially inserted through the transaxillary approach.  I also want to say a word about the transaxillary approach in these situations.  That approach to breast augmentation is the one approach that offers the least opportunity to do anything directly to the breast, because everything is done through a small incision in the armpit, and you have no opportunity to influence the breast other than basically what an implant will do.  You cannot do any lift directly from that approach, you cannot really modify the breast tissue or stabilize the inframammary fold, and you cannot typically perform dual plane placement of the implants the same from that approach as you could from another approach.  In addition, although the scar may be in the armpit, in my experience, it can actually wind up being longer than scars in other areas for the same size implants.  Also, being in the armpit, it is in an area that is very likely to be exposed with certain clothing styles or bathing suits, as opposed to a scar on the breast, which most ladies wouldn’t expose.  When those transaxillary scars heal well, they can look good, but when they don’t heal well, which happens regularly, they can be very conspicuoius - more conspicuous than scars actually on the breast.  In addition, if you ever did need or want a lift, or heaven forbid that you might require something like a capsulectomy for capsule contracture, you would have to do an entirely different approach at that point, and that would result in scars on the breasts anyhow.  Plus you would then be stuck with the scars in the armpits.  But, again, if you are committed to a transaxillary approach, and you fully understand all of those things that I mentioned above, I think it is reasonable to go ahead and do it for you.  The main thing to recognize here is that all operations have limitations, and you just need to understand what those are for each operation you are contemplating, and if you can accept the possibility of a less dramatic or favorable outcome in exchange for a more limited procedure, then I think it’s appropriate to go that route.

Be sure that you have consulted with only board certified plastic surgeons, as they will be the best equipped to discuss all of your options with you and to advise you properly.  Although you may get differing opinions, you can at least rest assured that the surgeon advising you has a certain minimum level of training and is competent to perform the surgery.  In addition to being certified by the American Board of Plastic Surgery, your surgeon should also voluntarily participate in the Maintenance of Certification program administered by that board. This is the best way to know that your surgeon not only has the best training and experience for the procedure, but that he or she has maintained currency in the certification requirements as opposed to practicing on a "lifetime" certificate which has only been reviewed once at the beginning of his or her career. For more information on this you can visit ABplsurg.org, ABMS.org, and certificationmatters.org .   Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

Can I avoid Benelli lift and have Breast Augmentation only? (photos)

Hi-  Unfortunately for the best breast shape you would need a lift, especially if considering a 200cc implant because it would not fill your deflated breast envelope. I also would not recommend a trans-axillary augmentation since you would need the lift. If you did not have the lift your breast would fall off the implant giving an unaesthetic result. Good Luck

Jordan P. Farkas, MD
Paramus Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast lift vs no lift

A breast lift will give you a significantly better outcome compared to just doing implants alone. If your surgeons can show before and after photos of women with the same degree of breast ptosis with a desireable outcome this may be different but I doubt this is the case. I understand the concern about visible scars but unfortunately you will not have a good breast shape without the scars. Please keep in mind these scars do fade with time. Best of luck

Josh Olson MD

Josh Olson, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 89 reviews

Avoid Lift

Look I completely understand why patients do not want scars on their breasts. The simple fact remains that in order to create a youthful breast with good round shape often times borderline patients are better off with a lift. For you some kind of discussion needs to take place about a skin tightening procedure. I feel from what you show there that you will just have bigger breasts that look like they do now. Certainly we do have some techniques such as a dual plane technique that in borderline patients can be done to avoid the lift, but I really caution you that you should be giving consent to allow your surgeon to proceed with a full lift (Vertical or Anchor Incision) so that if during the case they realize that in no way will an implant give you what they want, then they have permission to proceed. If you are totally against scars on your breast, I often tell patients in your shoes, you are better off without surgery at all. IF YOU NEED A LIFT, YOU NEED A LIFT! I am not a huge fan of the Benelli either. I feel it short cuts the real issue. There are some patients who are perfect for that, moving the nipple about 1cm maybe a little more. But, most patients need a more aggressive move of the nipple an that requires a full lift. But, also you get better skin tightening in the proper areas with full lifts. Just make sure you are educated. Sometimes I just can't tell a patient until get the implant in place in the operating room. Good luck

Sincerely,

DrRickAZ

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 49 reviews

Breast augmentation and a breast lift (mastopexy)

It sounds like you have done your homework but sometimes getting so many opinions muddies the water. It is really difficult to tell on photos because a surgeon cannot assess skin quality by just viewing a photo.  Some gals have really stretchy skin and stretchmarks, so even if the nipple position is only a little low, the skin might cascade over the implant.

For my patients, if they are adamant that they don't want further scarring on the breast, then I tell them that we can do the augmentation but we will have to re-evaluate in 6 months. At that time, the implant will be in good position and we can see what type of mastopexy needs to be done or if no further surgery is necessary. Every patient also has different goals and realistic expectations. I think a conservative approach is better.

Make sure to go to a board certified plastic surgeon with experience in augmentation and breast lifts.

Best to you on your decision.  Go with your gut feeling and feeling comfortable with the surgeon.

Elisa A. Burgess, MD
Portland Plastic Surgeon
4.9 out of 5 stars 50 reviews

Breast lift with implant

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 wise pattern breast lift. Your nipple sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A wise pattern lift with an implant can result in a very nice shape if good technique is used.  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.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

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.