Mastopexy, or not? Size of implants? Different size implants to correct asymmetry? If so what size each and type of each? (Photo

I am 42 y/o, 5 ft 1 in, 120 lbs, status post 2 children, athletic. Aiming for a D cup? Currently C cup. One female Dr recommend a minor areolar incision type mastopexy, and augmentation with 2 different size implants, to help with asymetry. Both recommend behind the muscle, silicone. Other surgeon said definitely no need for mastopexy, or different size implants, just need implants maybe 375 to 450 silicone round. If I am going to have surgery, I want symetry, perkiness, and volume. Please help?

Doctor Answers 16

Breast lift and implant

Your symmetry is very good already and no woman has perfectly symmetrical breasts. If you have two different sized implants placed, they may appear asymmetrical and be more bothersome to you than your natural appearance. Whether or not you need a breast lift will depend on your exam. A minor breast lift may not have much of an impact to your breast shape and only additional scarring. I would recommend returning to your surgeon(s) for further discussions about what your realistic expectations should be.

Appropriate for mastopexy and variation in implant size selection

Your selfie picture has your camera arm elevated which will affect the apparent nipple position on the breast mound and can give an impression of asymmetry.  The best quality pictures are taken further away with your arms at your side. I would agree that silicone implants behind the muscle of the sizes you suggest may do well. One of the best methods to choose implant sizes and evaluate asymmetry, if present, is to use the external sizers from Mentor, with a bra and top of your choosing.  (A top like you show in your last picture could be used as well.)  Implants will give a little lift, but a mastopexy using incisions around the areola will probably best meet your goals.  With the implants your areolar diameter will be stretched larger and that may be disproportionate for the breast mound. Thus the circumareolar mastopexy will help with both issues. One of the guides we use during pre-op evaluation and planning is that the nipple should be about half way between the shoulder and the elbow with your arms at your side. The other is how much of your breast skin is seen between the inferior edge of the areola and the lower visual border of your breast, which many times is at the inframammary fold of the breast.

John M. Weeter, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 6 reviews

Depends on expectations

This is probably the most common question asked by my cosmetic breast patients with any droopiness or ptosis of their breasts. There is no absolute or correct answer. It depends on your (the patient's) expectations and desires. Just remember the implant needs to be centered directly behind the nipple, so wherever your breasts/nipple sit currently this is approximately where you can expect the implant to be positioned/settle. Breast implants alone simply add volume to your breasts. They do not lift or shape your breasts. If you are happy with the look of your breasts and just want them to be a bit fuller then a breast augmentation alone may work.
In my practice, my patient's generally expect superior pole fullness/cleavage and a youthful, perky breast appearance without wearing a push-up bra so I tend to offer more lifts. Most of these patients are initially hesitant about the scarring, when in fact they should be more concerned about breast shape, contour and nipple position. I educated them that scars mature and fade over 6-12 months, when breast shape, contour and nipple position generally don't improve and, may in fact, worsen over time.
In my experience you could certainly have an augmentation alone and end up with a "natural" or "matronly" result. You may be perfectly happy and satisfied with your result. However, many of my patients who chose this route then will come back with a horizontal tan line across their chests (above the top of their implants) from a sundress or tube top, asking why when they wear a sundress or top without a bra, their breasts sit low, or do not have superior fullness. I re-explain that the implant must be centered behind their nipple and that generating this superior fullness would require a larger implant combined with a lift. Some elect to have the lift, and others chose to push their breasts up in a bra to generate superior fullness and cleavage.
Finally, attempting to avoid a lift by using an extremely large, high or extra high profile implant is a nothing more than a short term Band-Aid, and does not address the root cause/problem (i.e. stretched/lax and excess skin/tissue). This does nothing but postpones the lift for a short period of time and will only lead to further tissue stretch and thinning requiring an even larger lift to fix. Ultimately, this approach generates a much more complex (and expensive) surgical problem just months to a few short years down the road, so I never encourage patients to go with this approach.
Some of you may then ask why some surgeons you've seen offer this approach to droopy breasts, typically without discussing the other abovementioned options and each options pros and cons. The truth is that it's far easier and quicker for a surgeon to place a large implant without regard for the durability, or lack thereof, than perform a more technically challenging, and longer, lift procedure.

There is no one right answer

I always recommend implants under the muscle -- better long-term shape, less interference with mammograms, lower risk of capsular contracture.  So, an implant under the muscle would either need to be sizable and a high profile (resulting in a breast larger than a D cup) or a smaller implant combined with a vertical breast lift (in my opinion).  The photo of your goal is hard to assess because she's jumping.  That fullness in the top of the breast is probably from that -- it would look much softer if she were standing still.  Asymmetric implants is a possibility, but it would be slight.  Good luck!

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 15 reviews

Yes for Lift

Hi xtm 72,

As you can see, there are a variety of different opinions regarding your condition.

In cases like yours, I would have you consider having a  periareolar lift with silicone implants placed above the muscle. You have low-lying breast and some ptosis. The muscle is not your friend in this case. We want the implant to have the maximum effect on your breast and the muscle simply gets in the way of achieving this. Different size implants make sense since your breasts are not the same volume presently.

Good Luck!

Alfonso Oliva, MD, FACS
Spokane Plastic Surgeon
5.0 out of 5 stars 35 reviews

Mastopexy not needed.

You do not need mastopexy.  Implant sizes can be same or slightly different with minimal impact to final outcome.  Absolute symmetry is not possible either way. 

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Mastopexy, or not? Size of implants? Different size implants to correct asymmetry? If so what size each and type of each?

If you want breast implants under muscle and want symmetry then you will need the lift and probably different sized implants. Smooth round implants give the most natural result in my opinion. For more information on breast asymmetry please read the following link:

To lift or not?

You ask a very pertinent question.  If you want to be a D cup and have a rounded look (based on the picture you showed) one option would be to go over the muscle with a larger implant.  This however will have trade-offs in the long run. (such as greater need for a lift down the road and bigger risk of capsular contracture). If you were to go under the muscle, then you would need a lift in order to avoid the "double bubble" outcome.  I agree with Dr Singer that only a plastic surgeon who has examined you can truly assess the situation and give you the best advice.

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
4.8 out of 5 stars 26 reviews

Lift + implants

Without a lift, the nipple position will still likely be too low for a pretty breast shape, and the resulting breast would look bigger, but still droopy.
I agree with the idea of doing a periareolar lift ("donut mastopexy") along with the desired size of implants. 

In person examination would be needed to sort out the exact size and shape.

All the best,

Mastopexy, or not? Size of implants? Different size implants to correct asymmetry?

Implants alone do not adequately lift the breast when there is significant sagging, no matter the size or the type, and will not produce a good cosmetic result in a patient who also needs some variation of a lift.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do 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 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 and be very realistic about your potential cosmetic result.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.