Do I need a lift, or will 450cc implants fill me out and lift me a little? (Photo)

Last year I went for a consult and did not need a lift. However, I was not my ideal weight (due to menopause!) Since February I've lost 25 pounds. I am 5'3" and weight 120 lbs. I was always a D but with the weight loss I am probably a B. I want my cleavage back. I would like to avoid a lift if possible. One doc says no lift, and the other one says yes to the lift. Looking for some more advice. I reviewed quite a few cases on RealSelf where a lift was not needed. Thank you for your time!

Doctor Answers 19

Breasts augmentation with a full lift

Dear Floridian,
   Thanks for submitting your pictures. From observing your pictures, you appear to be small C cup with very large areolas and severe level 2 ptosis. If you were my patient, I would not do breasts augmentation alone on you for the following reasons : 1. Your nipples are very low and trying to lift them up with implants, means lowering the IMF (infra mammary fold ) too low, to a point where the breasts will be too low on the chest which is very unattractive. 2. Most likely the IMF will not stretch enough and you will end up with double bubble. 3. Your areolas are very large and will get larger with big implants which is unattractive. 4. When the IMF is not lowered enough, the ptosis will get worse.
 The scars of the full lift ( key hole ) are a compromise, but they fade away with time. Most importantly, the beautiful breasts are well worth the compromise ( that is what my patients tell me ). As far as implants size , you did not provide you chest circumference measurement in inches, which is critical for correct implants size selection. Let's assume that you are 36 small A cup. To become 36 D cup, you will need implants with a volume of 275 cc. This is much lighter than 450 cc and will weigh less on your shoulder as well as ease on your movement.
   Always consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Check the before and after pictures in the photo gallery (similar anatomy to yours), to make sure that they are numerous, consistent and  attractive.
                            Best of luck,
                                                  Dr Widder

Do I need a lift?

From your photos- it appears that would benefit from mastopexy ( breast lift) with possible implants. Implants alone will only increase the size of your breasts. Seek an experienced Board Certified PS for in person consultation. 

Need a lift

Yes there are options but a lift with implants is likely to give you the best long term stable result. Above the muscle will put all the weight of the implant on your  skin and is not a good option. Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 53 reviews

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Do I need a lift, or will 450cc implants fill me out and lift me a little?

Thank you for the question and pictures. Congratulations on your weight loss!

Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery.  Breast augmentation surgery, in my opinion, will not achieve an outcome that you will be pleased with long-term.

You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.

Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, 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 increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.  

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.

 
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. 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.

Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. 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 in 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.

Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. The attached link may also be helpful. Best wishes.

Do I need a lift, or will 450cc implants fill me out and lift me a little?

Thank you for your question.  It is important understand the breast implants will not lift the breast.  Based on your photographs if you choose not to have a lift your breast implants will have to be placed on top of the muscle under the breast and could cause further sagging.

If you feel you want her breast lifted and you will need a surgical breast lift.

The concern with attempting to place large implants under the breast to avoid a lift risks further sagging of the breast in time.

Do I need a lift

A breast lift would give you a more youthful shape to the breast and address the excess skin you have. A breast augmentation alone would only address the volume loss. If you like the shape of your breast now you could get away with just an implant but will likely need to go back for a lift eventually. Please seek an in person consultation with a board certified in your area. Good luck. Dean Vistnes.

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 42 reviews

Do I need a lift, or will 450cc implants fill me out and lift me a little

I do think you would be better off with the implant and a lift. The implant alone will fill you up, and in a bra you will have cleavage, but you will still be saggy without the bra. I think the lift and implant would yield a better cosmetic result

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 25 reviews

Lift

I also believe that you will need a lift with this current state of your breasts.  If you do not do a lift, the breast gland will still be too low in relation to the implant even if they are over the muscle, which I do not recommend.

Ramiro Morales, Jr., MD
Pembroke Pines Plastic Surgeon
4.6 out of 5 stars 22 reviews

Breast Lift?

If you choose to put implants under the muscle then you will absolutely need a significant breast lift.  Even the internal procedures that we frequently do with breast augmentation will not improve your result to where a lift is not neceesary.  You do have the option of placing the implant over the muscle in a slightly lower position.  If placed properly this could caiuse your tissue to rotate back over the implant giving you a reasonable result.  The problem with this surgery is that the results may not be long-lasting and, in your case, not something I'd recommend.  A breast lift with under-muscle augmentation is likely your best option and should yield a great/lasting result and scars that are far better than you imagine.  Good Luck!

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 40 reviews

Do I need a lift, or will 450cc implants fill me out and lift me a little?

Based on your photos I would recommend doing a lift with or without an implant (optional). I would not do augmentation alone. 

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 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.