No one wants the additional scaring of a lift! But if needed, a lift will result in a beautiful shaped, perky breast and hopefully, (and in most cases,) minimal scars! Basically, if you need a lift....... You need a lift! To get a nice shape, your nipples need to be over the fullest part of your implants! Believe me, if I could do this without a lift, I definitely would! No-one wants additional scars! But, if you need them, you need them! Usually, they aren't bad! Scars fade over the first 1-2 years! Initially, they are obvious! But, with time, they will fade! Breast lifts and Implants look BEAUTIFUL! Keep an open mind and, I agree with Dr Seckel. Implants on top of the muscle are more palpable are more of a problem. There are some docs who still do them that way, but they are a rare bird! They see the breast augmentation world from a different perspective! I'm not a believer! Under the muscle is better in so many ways!
Thank you for your question. It is very important that you have a lot of breast tissue to cover and conceal breast implants placed on top of the muscle. In particular textured implant walls are thicker and easier to feel. In borderline cases that have mild pseudoptosis a dual plane breast augmentation allows for the implant to be placed under the muscle and the breast to be properly redraped over the new mound. If your nipple is below the fold under your breast a combination breast lift with implants placed under the muscle may be her best option. For more information please read the link below:
Determining what would be best for you requires an in person exam and discussion of you goals. In general, I prefer placing implants under the muscle and using round smooth implants. As for a low nipple you may need a lift.
I appreciate your question.
Difficult to comment without examining you. That would be the best way to assess and give true advice.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
best of luck!
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute
Hard to determine without a photo as well as an in-office exam. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery.
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon
Keep in mind that following the
advice from a surgeon on this or any other website who proposes to tell you
what to do without seeing photos and more importantly without examining you, physically feeling the tissue, assessing your
desired outcome, taking a full medical history, and discussing the pros and
cons of each operative procedure would not be in your best interest. I would
suggest that your plastic surgeon be certified by the American Board of Plastic
Surgery and ideally a member of the American Society for Aesthetic Plastic
Surgery (ASAPS) that you trust and are comfortable with. You should discuss
your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
Hard to answer this question without photos or an in person exam. If you are worried, best to have another consultation with your surgeon so you both are on the same page. Good luck!!
Without a photo it's difficult to give you any concrete advice. Generally speaking, one of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask, “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.
Without seeing you in person or any photos, it would be difficult to give an opinion. However, 400-450cc is a larger implant. If your left nipple is pointing downward, it sounds like you have some sagging as you mentioned. The weight of these implants will speed up the amount of sagging that naturally occurs with time, and a breast lift would probably be necessary in the nearer future.