Will I need a lift? Will my nipples face east west instead of towards the front? Will my scar be awful? (Photo)

Question

I have nursed three kids and my breast look like empty socks. I would love to have a breast augmentation but I am affraid of three thing . 1. My cleavage still too far apart from each other 2. My current t breast being too saggy to accommodate an implant without a lift 3. Scars! I don't scar pretty at all! And my body usually takes forever to heal. Any other options other than under the breast fold?

Sheila S. Nazarian, MD · Answer

You don't look to need a lift. However, you do appear to have somewhat difficult breasts for an augmentation so make sure that you have a very honest and clear discussion with your surgeon about your expectations so that you are not disappointed in your results. My best,Dr. Sheila Nazarian@drsheilanazarian on Instagram

Sophie Ricketts, MBBS (Hons), FRACS (Plast) · Answer

Hi, Your concerns about the direction that your nipples point and your cleavage are valid ones.Certainly if you were to ignore where your nipples are positioned on your breasts for a second, your breasts could likely do ok with an implant only and no lift.BUT, it would likely push the nipples further East/West and because of the shape of your chest wall not significantly improve your cleavage. The nipple position can be brought closer to the midline via a peri-areolar incision (a scar around the areolar) to some degree. The cleavage is a harder problem to address. Care should be taken in developing the 'pocket' in which the implant sits during your surgery, but it is hard to give great cleavage in your chest shape, and you need to be aware of the limitations with regard to this.All the best.

Austin Hayes, MD · Answer

It's a good question. Based on your photographs, it does not appear that you would need a lift. Of course an in person examination is needed for definitive recommendations, but it appears that you would do well with a breast augmentation alone.Most women's breasts face different directions and do not point straight ahead. You mentioned that your cleavage is a little far apart. This will not change with a breast augmentation. The implant sits in the natural breast base, so it does not bring the breasts closer together. After an augmentation, you can create cleavage by wearing a push up bra.You'll get the most helpful answers by visiting a board-certified plastic surgeon in person. They will be able to answer all of your questions, so that you can decide which procedures are right for you.

Curtis Wong, MD · Answer

but your nipples do point lateral and this is not usually addressed as it will produce scars to move the complex.  Most patients can adjust to this and appreciate the nicer and fuller look they have and the nipple position becomes less concerning since this is your natural appearance.

Richard Chaffoo, MD, FACS, FICS · Answer

Hi and thanks for your question. Breast augmentation might be all that you need but the only person who can determine that is the plastic surgeon who examines you. The position of your breasts (far apart) will not be affected by breast augmentation which simply enlarges the breasts but doesn't really move them closer together. Most breast augmentation/lift scars typically heal quite well even in patients who indicate that they don't scar very well. After 30 years practicing aesthetic plastic surgery my best advice is to see a very experienced plastic surgeon who is certified by the American Board of Plastic Surgery. Good luck.Richard Chaffoo, MD, FACS, FICSTriple Board Certified Plastic Surgeon

Jon A. Perlman, MD (retired) · Answer

Thank you for your multiple questions. They can best be answered with precision during a face-to-face consultation with an ABPS board-certified plastic surgeon who has the opportunity to examine you.Having said that, I would be planning a periareolar or Benelli mastopexy with partial subpectoral placement of properly sized round smooth silicone mid-profile implants. Your cleavage will not be dramatically changed but the issue of wide placement of your nipples is important and can only be modified to a limited degree. Consequently, your surgeon must be accomplished and make the effort to find the best implant size to provide optimal aesthetics.Be certain to discuss realistic expectations with your doctor before proceeding and review all of your options and choices carefully.Jon A Perlman M.D., FACSCertified, American Board of Plastic SurgeryABC-TV Extreme Makeover Plastic SurgeonBeverly Hills, California

Brian Windle, MD (retired) · Answer

Your photos are helpful. 
It appears that you have just lost volume and that a breast implant or
breast augmentation is all that is required. 
Depending upon your goals, you may want an areolar reduction but that
will entail scars and is not necessary to get a good shape.  You do have a wide sternum and although we
cannot narrow this, the natural feeling, shaped, gummy bear silicone implants
form Sientra placed above the muscle so that the implants can be closer
together would work nicely for you.  I
also recommend a 24-hour rapid recovery protocol to get you going faster and reduce
any complications.

I have added a link and video for you about all of this.

I hope that helps.

Best regards.

Robert M. Grenley, MD (retired) · Answer

You do not look like you will require a breast lift, as an implant will fill out your loose skin without one. You do appear to have some form of constricted breast, with larger and low areolae, and a narrow based breast.Your distance from areola to crease seems a bit short, so some lowering of the inframammary crease may be required. If you want your areolae to be smaller in diameter, then a periareolar lift could be performed...if you are not concerned with your areolar size and want to avoid the areaolar scars, then you will not necessarily  need this. As to the distance between your breasts, you are correct that it will be difficult in you to place implants very close together without your nipples appearing to be even farther apart and facing too much to the sides. Augmentation will give you better fullness medially than you have now (and better breast shape), but your implants may not be as close together as in some patients whose breasts are much closer to start with. In seeking the benefits of a procedure, all patients must accept the constraints of their anatomy and have realistic expectations or choose to not do the procedure.

Ronald V. DeMars, MD (Retired) · Answer

The final appearance after a breast augment is always a reflection of the starting anatomy. In a normal breast the nipples always point slightly to the side, not directly forward. Your nipples are high enough that no lift is required to get a good result, but you will always have a slightly wide cleavage, although not as wide as now. Your aesthetics could be improved by an areolar reduction and that could also be the incision for implant insertion. Or an armpit incision is a choice although it has been shown to have a slightly higher rate of infection in publishwed reports.

Will I need a lift? Will my nipples face east west instead of towards the front? Will my scar be awful? (Photo)

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