Can I get a good natural looking result by getting approx. 350 cc Sientra textured teardrop shaped implants w/o lift? (photo)

I have breastfed two babies, 34 years old, 5'6" and 145 lbs. Consult today. Advised I am right on cusp of needing a surgical lift and being OK with just an implant. Thinks the Sientras can lift my nipples a bit. Advised I do the implants first then if not happy with the height of my breasts he can perform a small lift under local in office to save time/$. Says I don't have enough sagging to need serious surgical lift.

Doctor Answers 11

Vertical mastopexy needed

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You have significant ptosis (sag) with your nipples at the bottom of the breast and below the fold. In my opinion based on the photos provided, you will need a lift with an appropriate sized implant to get the shape and nipple position you are looking for. Thanks for sharing.

Implants do NOT "lift" nipple position.

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I like the fact that you are seeing an ABPS-certified plastic surgeon, since Sientra sells their implants only to BC/Board-eligible Plastic surgeons. I also like the fact that your surgeon is willing to discuss augmentation alone vs. "automatic" lift plus implants for someone who is "borderline." Whether or not you are truly borderline would require personal examination, but your photos suggest that you are more droopy than "borderline" and would not do well with implants alone.

This raises my other concern. Adding a lift secondarily is always an option, but if the initial assessment ends up being wrong, and you DO need a lift, a crescent or periareolar lift are the only two types of lift that can realistically be performed under local anesthesia, and I believe neither of those types of "lift" will adequately deal with your degree of ptosis. Meaning you will end up with another operation to do the proper "full lift" and general anesthesia to accomplish this. (NOT saving time or $)

This type of scenario is what happened to my patient who underwent 3 breast surgeries by two surgeons (elsewhere) before she came to me for the 4th and final "proper" operation she should have had in the first place. You can click on the web reference link below to see photographs of this patient and what I did to correct the vertical (lollipop) lift on one side, and the periareolar "lift" on the other side. You do NOT have to go through this sequence of events! Best wishes! Dr. Tholen

Teardrop shaped implants

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Teardrop shaped implants have very specific indications. They fit best in a particular type of breast, usually one with a tighter skin envelope and not a lot of droop.  Make sure you review your expectations with your plastic surgeon. 

Can I get a good natural looking result by getting approx. 350 cc Sientra textured teardrop shaped implants w/o lift?

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Thank you for the question and pictures.   Based on your photographs, you should have a very nice outcome with breast augmentation/lifting surgery. Breast augmentation surgery alone, is unlikely to achieve an outcome that you will be pleased with long-term. Unfortunately, in regards to specific size/profile of breast implant, despite good intentions, online consultants will not be able to provide you with  meaningful specific advice.  Ultimately,  you will do well spending additional time with your plastic surgeon communicating your goals, questions, and concerns. Do not proceed to the operating room until you feel comfortable that you are both on the same page when it comes to the goals you are trying to achieve.  In other words, careful measurements, dimensional planning, and careful communication will be key.

Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.  

2.  Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.

 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  The use of computer imaging may be very helpful during this communication phase.

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.  The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.

I hope this, and the attached link, helps.

I doubt you will get a satisfactory natural looking result with a tear drop implant without lift

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Based upon the images you show, you have what is in my opinion obvious ptosis, or drooping, of both the nipples and the breast tissue, and the history of breastfeeding twice pretty much seals this.  This will not change with an implant alone, and especially a Sientra tear drop implant, which is textured.  I don't have a crystal ball, but I have lots of experience to rely on, and based upon that experience I would bet money that you will not get the elevation of either the breast tissue or the nipples that your surgeon thinks you will and that you hope you will.  I'm sorry if I am being blunt, but I think you ladies come on this forum with these questions and want honest answers to help you make a decision, and it is our responsibility to tell you the truth as best we can see it.  I wouldn't suggest an implant alone, nor would I suggest a staged approach the way that you and your surgeon are discussing, especially with textured implants.  I  think the idea that you could do without a lift is wishful thinking, and when you do finally discover that you needed the lift after all, you will have put in textured shaped implants as a first stage, and this will make things harder, not easier, and it will be something that is not easily accomplished under local anesthesia in the office.

Let me explain why I have the opinions I have so that you don't think I'm just being overly critical of your plan.  One of the main reasons why we use textured implants is to keep the implants stable and prevent them from moving and shifting in the tissues; this is especially true of the shaped implants.  The problem with using a textured implant in the case of a lift or of loose breast tissue that you want to move or shift over the implant, i.e., as we would expect with just an augmentation and a dual plane procedure, is that the texturing will prevent this movement of the breast tissue against the implant, and the implant will stay put, and the breast tissue will sag over the implant.  In addition to this, if the nipple is low enough to begin with, which in my opinion yours is, then it won't raise on its own with just an implant.  Your nipples are almost on the bottom contour of your breast curve, and there is no visible skin below the areola from the front.  This will not change with an implant alone.  In addition to this, shaped implants are really best used in girls with small volume breasts who need the reduced upper pole projection to avoid an obviously implanted look.  In this setting, the implant is creating to a large degree the shape and contour of the breast, and we don't want it to shift or move at all.  In the case of a lax pendulous breast, we are either trying to get the implant alone to fill the breast envelope and create a single, natural appearing contour, or we are using the implant in conjunction with a lift, and we still want it to fill the envelope and create a natural contour.  In either case, however, we want the implant to be able to shift slightly with the tissues and vice versa as the tissues settle with gravity and adopt to the new shape of the breast.  As I just said above, the last thing we want to do is lose control of position with a shaped implant and allow it to "settle" with gravity.  Therefore, I don't think shaped implants are the best choice in the case of a lady who needs a true breast lift, and I think you are one of those.  

If you are committed to this plan, I would encourage you to at least push the envelope on the volume of the implants as much as you are comfortable, as you will need the extra volume to fill the loose breast envelope - and this is not just skin, mind you, but loose breast TISSUE which as lost its support framework and will continue to sag if not managed properly.  Doing skin only lifts in cases like this will result in either distortion of the breast shape or recurrent sagging of the lax breast tissues which were never really lifted and tightened in the first place.  The largest shaped implant that Sientra makes in the classic base is 450 cc and in the round base is 425 cc.  I doubt you'd be happy with the dimensions of the other oval based shaped implants as they are low and "squatty" for most girls.  The round base has a higher projection height and may give you the maximum of the nipple raising effect that any of the options might.  A volume of 350 cc is rather modest given your height, weight, and frame size, especially for a shaped implant, and you can usually "cheat up" in volume a bit and still look good because the shape protects against that round, obvious look.  But again, this is my second choice recommendation; my first choice is to consider a proper lift with a round implant.  And if you are going to stage the two, I would do the lift first, and then the augmentation second, as it is typically much easier to augment a properly lifted breast than to try to fit a lift around an implant which may or may not be in the optimal position.

Those are my best thoughts for you, good luck!

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

Augmentation with or without a lift...

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Hi - The photos certainly show breast ptosis.  If your nipple is lower than the fold under each breast, augmentation helps a bit, but a small lift may be necessary.  There is nothing wrong with augmentation with Sientra gel implants first and determining whether a lift is going to be necessary after a relatively short period of time.  It is refreshing that you had this conversation with your surgeon already...I feel confident that you will do well.  Remember, education is the first step toward being a happy patient.

Good luck!  

Dr. D.

Gary R. Donath, MD
San Luis Obispo Plastic Surgeon

Sientra Breast Implants

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From the photos you provide, none of the shaped implants will look as pleasing as a vertical breast lift with implants. 

Sientra Breast implant Aug with or without a lift

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I think you will have a better result with a lift and Sientra implant than with a shaped Sientra implant alone.

I have seen many women with your situation and you have to know what you are interested in to really answer the question.
If you don't mind a lower nipple position after just an augmentation- then the shaped Sientra implants may be enough for you. Most women want to look youthful and have options of bra wearing after augmentation surgery and I think you will be limited and will always need a bra with just an augmentation.

Of course the trade off for you are the additional scars associated with a lift vs. just an augmentation. if the scars and cost are acceptable, I think you will be happier with the combination of the lift and augmentation.

Sientra Implants

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Put an index card in your breast fold. If your nipple is at the edge of the card or below, you would be a candidate for a lift, either a vertical or anchor or areolar. If you nipple is above the edge, you could be a candidate for an internal dual plane lift called the dual plane (see web reference below).  I already know you are seeing a board certified plastic surgeon because Sientra only sells to BC plastic surgeons (by ABPS - The American Board of Plastic Surgery) who are members of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). So that is great!  There is nothing wrong with two staging it as you and your surgeon have decided.  You will get some lift with the treardrop "shaped" Sientra implant. They have round implants (with or without texture), and also shaped implants which can provide a nice "tear-drop" shape for women who want a very natural and "athletic" look.  All the best, "Dr. Joe"

Can I get a good natural looking result by getting teardrop shaped implants w/o lift?

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Your photos show that the nipples and breast tissue are so low I doubt you will reach your goals without a major lift.

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.