Deflation and asymmetry from breastfeeding. Lift, fat transfer, or implants? I want lasting upper pole fullness. (Photos)

Thank you for your question. The best way in your case to achieve an upper-pole fullness and a perky, symmetric shape is a combined breast lift with augmentation. This balances shape and longevity better than a lift alone or fat transfer alone. But you must understand that there is no permanent result: breasts change over time with aging, gravity, skin quality and elasticity, implant size and weight, weight fluctuations, future pregnancy and breastfeeding, and lifestyle factors (e.g., smoking, sun). Implants may need surveillance and eventual revision or exchange; lifts relax gradually. Fat grafting can be added for fine-tuning, but it is typically adjunctive rather than a substitute for the volume and structure provided by an implant. You must have an in-person examination with a board-certified surgeon to assess nipple position, skin envelope, tissue thickness, and base width, and to finalize sizing, lift pattern, and whether internal support is indicated.

A conservative way to proceed is with a breast lift to achieve maximal lift and tightening and best address the asymmetry. Then, if desired, you can proceed with either an appropriately sized saline (least risk/worrisome implant) or silicone implants. Or consider fat transfer. I hope this helps . . . thank you for sharing!

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.
Based on your photos, you would benefit from both in conjunction. Implants will restore volume and lift will shape and reposition NAC.
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.

Thanks for your question. From your pictures and since you want upper pole fullness, it seems like you would be a good candidate for a breast lift with implants. I recommend scheduling a consult for a proper evaluation. Please always consult with a board certified plastic surgeon. Take care, Dr. Moises Salama, board certified plastic surgeon.

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. 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. Surgical results could change again with significant weight change and/or another pregnancy. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

A breast lift is designed to reshape your perkiness, but as you already know, the results can be affected by aging, gravity, and other factors. However, that is the same for any cosmetic procedure, including breast augmentation and fat transfer. While your breasts may always look better than not having anything done, if you want something that will give you permanent results, there is nothing available at this time.

The first thing to know is that no surgery today will last permanently. Over time the breasts will sag due to gravity and age. The only way to achieve substantial upper pole fullness is with a breast implant. A breast lift is definitely indicated but this comes with scars. There is no perfect answer to your questions and you must decide whether surgery is right for you.

To address all your concerns: A breast augmentation will give you the volume that you are looking for, and if it is done asymmetrically, ie a larger implant for your smaller breast, you can improve the symmetry of your breasts. The augmentation will also give you predictable, reliable upper pole fullness. While concern about BII is understandable, this is an exceedingly rare. A breast lift will make your breasts more perky and youthful. Fat grafting has unpredictable results due to variable permanence of the fat. Your tissues, in your early 20’s, likely are of good quality so your result should last a long time. The effects of aging, gravity and lifestyle, plus the lifespan of implants may necessitate a future procedure, though this is true for any procedure. Have a detailed consultation with a board certified plastic surgeon. Best wishes.

Based on the photos and information provided the recommendation would be a breast lift with implants. I don't recommend fat transfer to the breast as microcalcifications can form and interfere with future imaging studies. A lift would improve asymmetry, remove excess skin, downsize the areola and raise the nipple. An implant will provide long lasting shape and volume. I've included a video I hope you find helpful.

You would benefit from a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.