Currently a very saggy 36D. Wondering what a full lift and 375cc implant may take me to? (Photo)

t 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 link below -

Thank you for your question and photos.  First, congrats on the weight loss!  I agree with your surgeon in that you must be careful in choosing implants after a full lift procedure as choosing implants that are too large can cause the results of the breast lift to become undone.  All the best,Dr. ResultsMiami, FL

It's hard to give you an exact letter because it depends on so many different factors - your base/width dimensions (BWD); your chest bandwidth; where you buy your bra; whether your lift will include reduction of breast tissue as well; etc.All that being said, if you are a 36 bra, then 240 ccs equals one cup and no breast tissue is removed, then you should go up approximately 1-1/2 cups, which means that the ultimate size of your new breasts should be approximately a DD.  Things to consider are that when breasts are lifted, they appear smaller than when they are ptotic (droopy).  The increase in cup size is dependent upon the manufacturer of the bra you choose to wear.  I personally feel a high profile or extra high profile breast implant will give you the greatest amount of lift along with you skin resection elevation. 

Congratulations on your weight loss and taking control of your health. Awesome. It sounds to me as if your surgeon has given you a really sound course of action. Also, remember not to focus on cup size as that can vary greatly between bra manufacturers. You want enough cc's to give you natural looking volume, but that also won't be so large that they eventually sag thus defeating the lift. Best, Dr. Nazarian

Hello dear, thanks for your question and provided information as well... The breasts may lose their elasticity and firmness
which can be caused by different factors such as pregnancy, massive weight
loss, lactation and aging. To reaffirm the breasts and restore the natural look
your surgeon can perform a mastopexy or breast lift with augmentation such as silicone implants high profile around 325 to 250 cc's to get your wanted result, hugs!

I think your surgeon is giving pretty sensible advice. It is not exactly true that an uplift would 'knock a size off' (there is no reduction in volume with the procedure), but most women would fit a smaller bra after an uplift. The most likely explanation for this is that women with saggy breasts tend to buy bras that are too big for them, and this is changed after the uplift.375 (grams or cc) should bring you in the DD range. Bigger than that is possible, but your breasts would sag again pretty quickly. 

Thank you for the question and pictures. Congratulations on your significant weight loss; you should be very proud of this accomplishment!  Some general thoughts regarding breast augmentation/lifting surgery may be helpful to you: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" or "implanted look" 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. 
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.