Mastopexy, or not? Size of implants? Different size implants to correct asymmetry? If so what size each and type of each? (Photo
Doctor Answers 16
Breast lift and implant
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.
Depends on expectations
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.
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There is no one right answer
Yes for Lift
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.
Mastopexy not needed.
Mastopexy, or not? Size of implants? Different size implants to correct asymmetry? If so what size each and type of each?
To lift or not?
Lift + implants
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?
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
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.