To lift or not to lift?

Question

Would it be reasonable to proceed with breast augmentation and then wait to see outcome before scheduling lift? My sternal notch to nipple measurement is 21. Left slight ptosis compared to right. My goal is for more upper fullness but proportional to my 5'3.5", 98# frame. Not looking to go large by any means. Thank you in advance.

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for question and photos.  I think that you are a worthy candidate for a breast augmentation to improve the upper pole fullness of your breasts.All the best,Dr. ResultsMiami, FL

Thomas P. Sterry, MD · Answer

I see no reason that you need to have a lift.  Based on your photos there is no evidence of clinical ptosis and your measurements are in line with the 18-24 centimeter average.  Why complicate matters if you can have an augmentation only?I agree with your instinct - get the augmentation and if you think you want a lift later, go ahead and do it separately.Good Luck!

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Hi PDScraftThanks for posting! We always love to hear from RS users, as this helps our community get great service. A couple of options for you, but make sure you see a qualified and experience surgeon.Breast Uplift (Mastopexy) removes skin from the underneath and the sides of the breast, and shapes the breast to give a natural and more youthful appearance. This is carefully measured and planned at your consultation and again immediately prior to surgery. The remaining skin is reshaped around the nipple and the resulting breast is uplifted. Scars are sited around the nipple pad.In some cases where only a small lift is required, no further scars are required. Where a more extensive lift is needed, a further scar is sited from the nipple pad vertically down to the breast crease and then side to side in the breast crease. These heal well and are generally very subtle once the healing process is complete.Breast enlargement using Breast Augmentation is achieved by positioning an implant between the breast tissue and the rib cage. This fills the breast, pushing it forwards and upwards. Breast size and cleavage are enhanced as a result. Breast Implants are introduced through a small surgical wound in the breast crease and the procedure takes approximately an hour. It is a day-case general anaesthetic operation. A soft supportive bra should be worn for 6 weeks after surgery.

James Lee, MD · Answer

Based on the photos submitted I believe a  breast augmentation without a lift (mastopexy) is a completely reasonable option and can give you the results you are looking for. You would always have the option to do a mastopexy later on, if need be. The implant will allow for a fuller volume and enhance the projection of your breasts. The augmentation procedure alone can also address a certain degree of ptosis (sagging) of your breasts. Upon consulting a Board Certified Plastic Surgeon, the ideal technique to insert the implant will be discussed as well as the type of implant that would best suit you leaving you with the natural balance you are looking for. James Lee

Gary M. Horndeski, MD · Answer

Thank you for your question and photos.Consider a minimal scar breast lift only without implants. If you are happy with your current volume, implants are not required to maximize the long term results from your lift. Upper pole fullness can be achieved with the Ultimate Breast Lift method. Breast implants are heavy and the larger they are, the more unstable they become. Please know that when breast implants are added, the sooner you will need revisionary surgery in the future. The FDA has determined that implants are not lifetime devices and need to be monitored closely.I hope this helps.Best wishes,Gary Horndeski M.D.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.From your photos, it appears an augmentation alone would be sufficient at this time to give you your desired results.

The size of implant best for you is dictated by your
chest wall measurements.  Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid
silicone (less cross-linked), if this implant should rupture, it will leak only
into the scar capsule formed around the implant but may cause some discomfort
or implant distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone gel
implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.Best of luck!

Dr. Schwartz

Board
Certified Plastic Surgeon

Director-Beverly
Hills Breast and Body Institute

#RealSelf100Surgeon

Dallas Buchanan, MD · Answer

Great question title! Thank you for your pictures and measurements as well. This is a very common question that many patients have when considering breast surgery. And the answer is different for every patient and depends on their exact anatomy, characteristics, implant choice, and goals. I would say that after examining your pictures and measurements, you could easily get an acceptable result that meets your goals with augmentation alone depending on what type and size of implant you choose. Often women who are just looking to replace lost volume, but have very little breast ptosis (drooping), are well served with an implant alone. I think your approach of doing the implant first and then considering a lift if needed later is a very reasonable approach. Make sure you see a qualified board certified plastic surgeon in your area for an exam and discussion of your goals and expectations.Best of luck and be safe!

Robert J. Spies, MD · Answer

Hello and thank you for sharing your question on RealSelf.com.Based on looking at your photos, I would say just get implants and avoid a lift at this time.  Yes, you can have a lift at a later date if there is persistent sagging of the breasts.  It does appear that your nipple is above your crease which should give you a great result with the implants.Good luck to you.Dr Spies

Justin Yovino, MD, FACS · Answer

You'll likely be satisfied with an implant only augmentation. You can always proceed with a lift as a second stage.

Mark A. Deuber, MD · Answer

Thanks for your question.  It is impossible, but based on your photos, it appears you could undergo dual plane augmentation with a moderate sized implant and achieve a very nice result without a lift procedure.  In addition to your notch to nipple distance, your nipple to fold distance is also important.  If this exceeds roughly 10 cm, there may simply be too much skin and you would require a very very large implant to fill out your skin envelope.  In that circumstance a lift type or skin reduction procedure could be necessary even though you nipple to notch distance suggests you wouldn't need it.

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