Why is it I can't get implants? I don't think I'm sagging that much and need a lift. Someone help (Photo)
Doctor Answers 9
Options for implants
I would encourage you to make a second in-person consultation with a ABPS board certified PS to evaluate you and discuss your options.
Hope that helps and best wishes!
ABPS Board Certified
Why is it I can't get implants? I don't think I'm sagging that much and need a lift. Someone help
Why is it I can't get implants? I don't think I'm sagging that much and need a lift.
Thank you for your question. Based on your photos, it appears that you have loose skin and pseudoptosis. You would be a good candidate for breast implants with a limited lift (lollipop scar). If you choose a larger sized implant, it would fill up your breast skin envelope, decreasing the possible need for a lift. That might be a consideration. You would need an in-person exam to tell for sure. Please consult with an experienced plastic surgeon certified by the American Board of Plastic Surgery. BTW, the average cost of a breast lift with implants based on numerous realself reviews as of today is $8850. Good luck!
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Why is it I can't get implants? I don't think I'm sagging that much and need a lift. Someone help
Why is it I can't get implants? I don't think I'm sagging that much and need a lift. Someone help.
Single versus two-stage breast augmentation/lifting surgery?
Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery. In my opinion, you will not do well with breast augmentation surgery alone.
Whether to do the breast augmentation/lifting procedure in a single versus two-stage fashion is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately and there are good plastic surgeons who can produce excellent outcomes in a single stage.
The combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time.
In my opinion, the decision to do the operation in a single or two staged fashion becomes a judgment call made by a surgeon after direct examination of the patient. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate. The analogy I use in my practice is that of a thinned out balloon, being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.
To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key. Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery.I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Ultimately my best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, working together you will come up with the best plan to achieve an outcome that you will be pleased with. Always maintain safety, as opposed to size concerns, your first priority.
I hope this, and the attached link, helps. Best wishes.
Lift with or without implants
Patients who goes to a consultation for drooping breasts (ptosis) or volume loss after pregnancy (pseudoptosis) almost always have one very important question. "Can my drooping be corrected with just implants or do I need a lift".
Implants alone will correct drooping when:
- Breast drooping is mild
- The nipple is still near the center breast and does not point downward
- There is some visible skin beneath the nipple/areola when looking at the breasts straight on.
- The patient is okay with being at least a cup size larger
- Breast drooping is moderate or severe
- The nipple is at the bottom of the breast or points downward
- There is no visible skin under the nipple/areola when looking at the breasts straight on.
- The patient is already a C or D cup breast size and doesn't want to be larger
- The areola is too large and the patient wants it reduced
I use implants in combination with a lift when:
- The patient wants to be larger in addition to being less droopy
- The patient desires to maintain projection and roundness of the breast mound
- The drooping is severe..... I recommend to see a board certified plastic surgeon for a personal evaluation and also to talk about your goals. Good luck :)
Price Quoted is Out of Line
Looking at your pictures, the nipple seems to be above the level of your fold, and I think you would be a good candidate for simply breast augmentation. Of course, if you wanted the highest-riding breasts and reduction of the areolae, then a lift would be appropriate, although the price you were quoted is clearly out of line.
I hope this has been helpful.
Robert D. Wilcox, MD
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.