I've been told by 1 doctor that I need a lift and augmentation. Can you tell that just by looking at pictures?

Hi, and thanks for the question. From your pictures, it looks like you will need a lift with your augmentation. What type of lift (and what type of scar will be necessary) will depend on your examination, measurements, and what size implant you decide to use. You may be able to limit the scar to around the areola, or you may need to extend the scar down from the areola to the fold.It is not unusual for patients to be surprised by the fact that a lift is necessary with a breast augmentation. Slight drooping of the breast can, in fact, be taken care of with an implant alone, but for moderate to severe drooping (and yours looks moderate) a lift is usually necessary with the implant for the best possible shape. It's never easy to come to terms with the fact that you will have the extra expense of the lift as well as longer, more visible scars, but, in the end, you will have a better shape and be happier with your results. The scars will fade and improve over time.I also don't think you necessarily need to go out of town, unless there are no board certified surgeons in your area. Your follow up care is important, and it is usually best to be close to your surgeon.Hope this helps!

Thank you for your question and for providing photos.  I believe you would be happier with your results if you undergo a breast lift with implants.  Your nipple areola complex is below your inframammary crease in the all of the photos except the side view.  This could be because your arms are above your head in the side view.  Implants alone will only fill you breasts and if you already have a degree of ptosis, this will not change.  Best of luck,

    I would agree that a lift with an implant would produce a better result.Kenneth Hughes, MDLos Angeles, CA

Hi SB,Please put an index card in your breast fold. If
your nipple is at the edge of the card or below, then you would be a candidate
for a lift, either a vertical or anchor or areolar incision. If your
nipple is above the edge, you could be a candidate for an internal lift called
the dual plane.Be sure to seek a
consultation with a BC PS to be sure. You appear to be pretty heavy breasted, so you would want an "in-person" consultation to really sort this all out.  All the best, “Dr. Joe”

I would say from your photos that you would get the best result with breast augmentation and mastopexy (breast lift). This combination is a challenging one and the source of a good deal of discussion among plastic surgeons on the best way to proceed. In fact there is a view that the procedure is so difficult and dangerous that it should always be done in two stages: lift, followed some time later by the augmentation. I disagree completely. However, the procedure is exacting and I recommend you identify a very experienced aesthetic breast surgeon in your community to guide you through your best options. Good luck!

It is possible to give an opinion based on photos, mainly because it's easy to see how your nipple/areola is located in relation to your inframammary fold. I would have to agree that a lift would be necessary, though it's always best to have an in-person assessment to discuss your goals. Based on your goals, a lift may not be necessary.

Dear SB1987,



It is difficult to say definitively by the
looks of your pictures, and really would require a physical exam and the measurements
that are done routinely at consultation. I admit on your front view and
45-degree view, it looks like you will most likely need implants and a lift;
however, your side view seems to show the nipple height well above your
underlying fold, and that is the critical element in determining whether you
have to have a lift or not. If the nipple is above the level of the fold but
you simply have laxity of the lower pole of the breast, this is called “pseudoptosis”
(fake drooping) in which case putting in an implant only will give an
acceptable result. This situation occurs when there is a mismatch between the
greater amount of skin present than is necessary for the decreased amount of
breast tissue.



I hope this has been helpful.



Robert D. Wilcox, MD

There are many ways to skin a cat!  You have very nice appearing breasts to start with and you have many options available to you to "enhance" your breasts.  Here are your options:Implants alone, silicone, on top of the muscleImplants and donut mastopexyImplants and lollipop mastopexyDo nothing!Please see a board certified plastic surgeon who specializes in these types of procedures to decide which choice is best for you.

Thank you for the question and pictures. Your pictures demonstrate   breast ptosis and you will benefit from breast augmentation/lifting surgery. For some patients the necessity of additional scars associated with breast lifting is a “dealbreaker”; for these patients it is better to avoid breast surgery altogether.
On the other hand, many 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. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.
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. 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.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. 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.

You will need breast lift to have a good outcome.  Dallas is plastic surgery hub.  Going out of Dallas for plastic surgery does not make sense to me.  However your doctor gave you a good advice.