What's the biggest implant I can have without risk of sagging with a breast lift? (Photo)

When getting your breast lift the insertion of an
implant as well, may be advisable to restore superior fullness, which is lost
with aging and after pregnancy despite the rest of the breast being overly
large. You appear to be asking about the maximum size implant that could be used when completing this process, but their are additional risks to placing the 400-500 cc implants that you mention in your question.Over time, gravity will continue to have an effect and the
breast skin will tend to stretch. The degree of #stretching and #sagging varies
between women: generally, women with smaller breasts experience less recurring
sagging. If sagging does occur, further excision of the skin on an outpatient
basis can be used to correct the problem. Heavy and large breasts may lead to
recurrent sagging and may require the removal of a small amount of breast
tissue to achieve an optimal shape and size. One key to a satisfying result is
realistic expectations.

A full mastopexy breast lift would be an excellent operation for you.  An implant that large at the time of a lift would potentially be a problem with wound healing and blood supply to the nipple.

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link:

Larger the implant more is the weight.  Risk of sagging is directly proportional to weight of implants.  Have a breast lift and use an implant that gives desired shape and fullness.  Do not be fixated on size.  Large size will be counterproductive in long haul.

Your question suggests frustration at the lack of uniformity among plastic surgeons and a lack of understanding of what you are asking for. You specugucally asked how large of an implant can be put in your (already) sagging breasts which would NOT risk further sagging. What you are asking for defies gravity and the laws of physics and aging. If your current I enhanced breasts sagged already why would they magically not sag again if any implant was added to them? Of course they would. Since current implants are filled with either saline or silicone gel NOT with lighter than air helium , even the smallest breast implant would add weight to the breast and pull it down. The larger the implant the greater the weight and the faster the pull and sagging. If you cannot accept this fact do not have the surgery. That us why some surgeons would rather not end sabotaging their breast lifts with large implants. If you wish to proceed you have three options:- breast lift alone - breast lift with immediate or delayed augmentation  delayed augmentation with yiur own fat. The most accurate way to control your breast size and shape would be to do the lift first and do the augmentation with implant or fat later. But it is up to you one what makes most sense to you. Good luckpeter Aldea , MD

I perform most lifts with a simultaneous submuscular augmentation. There are several things to consider in your case. It appears that your tissues have lost some elasticity and may benefit from a staged approach (performing the lift and then the augmentation at a later date.) If you have the lift and the implants both done at the same time then I recommend the following: 1)  consider using a textured implant to keep it from sagging, 2) your surgeon places your nipples about 20 centimeters from your sternal notch, 3) your surgeon allows a little extra distance between your nipples and the incision at the bottom of your breasts since your implant choice is rather large, and 4) you will most likely need to be prepared to have a second surgery about 6 months down the road to have some extra skin removed removed from the bottom have of your breast since it will probably loosen somewhat. If your surgeon tries to tighten the skin over your new implants too much then you will have an increased chance for complications. It is easier to leave a little extra skin inferiorly at the time of the original breast lift and simply remove it later once it has settled and stretched. Best of luck.

I believe you have much more breast tissue than you think. A well done breast lift can change your breast shape and all without the problems of implants. Your skin quality look poor, and as a result the problem of relapse, falling is high. I would suggest a lift first, see if you like it, if not then add volume with an augmentation. You have to remember the weight ( implant and breast) and gravity work together. You really don't want to have to redo this operations later because you bottomed out.Stephen M. Davis, MD, FACSGreen Hills Plastic surgery

Dear Destiny,Your plan to undergo a breast augmentation for upper pole fill along with a breast lift is a good one.  The size of implant that is placed is a personal choice dependent on the final breast size you desire and can be accommodated by adjusting the lift markings.  However, one of the more challenging procedures in plastic surgery is the combined breast augmentation and breast lift.  Consider staging the surgery if size is a great concern for you.  Good luck!

Thank you for the question and pictures. Although the majority of  breast augmentation/lifting procedures I perform, I do in a single stage, I would probably recommend that you undergo the planned procedures in 2 stages. In other words, I would suggest that you undergo the breast lifting surgery first, followed by the breast augmentation procedure at a second stage. Doing so, will help minimize risks of the procedures and  be more likely to achieve your desired outcome. Some general thoughts regarding breast augmentation/lifting surgery may be helpful: 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%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation.
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, while at the same time removing some of the balloons rubber surface.  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.  
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.

I do the majority of my augmentation mastopexy procedures as one combined surgery.  The fact that you want to use a large implant and have a lot of sagging I would recommend having a  lift first and then an augmentation as a second surgery.  This will give you a more predictable result and be much less risky.  Please make sure you see a Board Certified Plastic Surgeon.Gary Hall,MD