34C now, getting full lift + implant. Want to be DD, conflicted on size, do not want to compromise the lift at all!

Question

5.3, 130lbs, athletic. Currently a 36C or 34D, and stage 2-3 sagging and deflation of upper breast due to weight loss. Getting a full mastopexy + augmentation in 3 weeks. I would like to enlarge to a DD, however do not want to compromise the lift and end up back where I started. If I had to choose I would compensate size for longevity and quality. 250cc-350cc is what the Dr ordered. What will be the result and difference from the two? I desire to be high, tight, and round "as is possible".

Gerald Minniti, MD, FACS · Answer

Hello,It sounds like you would like your results to be similar to the result of a primary breast augmentation in a women with little and tight breast tissue: high, tight , and round.  In order to achieve that kind of results, you will need to recreate the ratio of implant volume to breast tissue volume, i.e. you'll need to not only get a lift, you'll need to reduce your breast tissue substantially and then replace it with a larger implant then originally planned.This might sound controversial, because it implies that 'perfectly good' breast tissue is being discarded and replaced with an inferior implant.  From a textural (how they feel) standpoint, that is true. But from a visual standpoint it is essential  to in fact do so. You cannot get a significant volume of breast tissue to look like an orb, no matter how tight the breast lift; it will always loosen and sag. Discuss this concept with your surgeon. If he doesn't understand or disagrees, you may wan to continue your consultations.Best of luck!

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question.  First, please be sure that you understand that it is nearly impossible to predict cup size prior to the breast augmentation procedure.  I think your surgeon made an excellent decision with the range of implant sizes that he/she has recommended.  I almost exclusively perform the full breast lift technique and use modestly-sized implants as to not "undo" the results of the lift.  I recommend that you ask your surgeon to "try on" different implants in his or her office to see what look you like best.All the best,Dr. ResultsMiami, FL

Ary Krau, MD, FACS · Answer

The conventional  dictum is that although the breast augmentation and breast lift procedures  need  be in harmony, they often work against each other. The augmentation stretches the breast while the lift tightens the breast.  There are techniques, however, in which both these procedures can be performed together so as to produce desired results safely and predictably. These results, as you described, include elevation of the breast and nipple to above the breast crease, as well as producing  upper pole convexity.  To achieve these goals, larger implants should be used with more aggressive removal of breast tissue.  This is the addition-subtraction principal. Therefore, if these techniques are used, one does not have to necessarily compromise on size to achieve an ideal lift.Good luck,Ary Krau MD FACS

Marshall T. Partington, MD, FACS · Answer

Balancing
fullness with a perky look,  this is always the goal in a mastopexy  augmentation.
The best way to achieve a happy result is to work back from your ideal look.
During a consultation I have patience try on implants in a sports bra. Thist will
give us an idea what they will look like afterwards, whether or not they have a
list as well. This way you can see what you look like both in and out of
clothes. Interestingly, a mastopexy decreases breast size by almost a cup
size without taking out breast tissue other than skin. This is because it takes
a longer looser breast and makes it more compact by tailoring the skin. That
plus the implant can give restoration of fullness and an upturned forward
nipple. The higher range of what your doctor has suggested sounds to me like it
will be closer to a double D. However cup sizes are very confusing and again you
are best served to literally try on the implants to decide your final choice.

Austin Hayes, MD · Answer

Without photos it's very difficult to give any useful advice.It's important to understand that a final cup size cannot be predicted after breast augmentation surgery. Cup sizes between bra manufacturers very and are not standardized.The implant volume of 250-350 cc seems reasonable. It's always a trade-off between going larger versus choosing a smaller implant which has less tendency to cause the breasts to sag and stretch over time.If any questions remain prior to surgery, you should definitely contact your surgeon. You should be able to have all of your questions answered, so that you can confidently move forward with surgery.

Tom J. Pousti, MD · Answer

Thank you for the question. Some general thoughts may be helpful to you as you learn more:
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. Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting 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 are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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 "DD cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

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, after the use of temporary intraoperative sizers.I hope this, and the attached link (dedicated to breast augmentation/lifting surgery concerns) helps. Best wishes.

Tania Medina de Garcia, MD · Answer

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, you will be a very good candidate for this procedure, don't choose large implants, because that can compromise your lift, if you dont want a lift, you have to check with your surgeon what's better for you, hugs!

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

Thanks for your question.  A photo would be helpful.A large implant will compromise the lift.   A lift by nature tightens the breast.  A large implant will by nature push against the lift.  It sounds to me like you have a very reasonable and experienced surgeon who is guiding you towards a reasonably sized implant.  And it just may be, because of your weight loss, you will not be able to get that really right and tight look you desire.  You should be aiming for the best look for your body, not some unobtainable look.  And I hear and read more and more about surgeons advising removal of normal breast tissue and replacing it with an implant for a right and tight look.   Maybe I am just old fashioned but I think that idea is nut fudge bat guano crazy.  The Big Plastic Surgeon in the Sky gave you breasts to last a life time.  The implant manufacturers make implants that will hold up well for maybe 20 years or so.  Think long term here.  I'm going with the Big Plastic Surgeon in the Sky.

Ronald V. DeMars, MD (Retired) · Answer

No one on this site can make any reasonable recommendations on surgery to change your looks without photos and no one can comment on implant size for a particular patient without an examination. Speak with your surgeon for the best answers. But the modest implant volumes you mention should reduce the risks involved in doing augmentation and lift simultaneously.

34C now, getting full lift + implant. Want to be DD, conflicted on size, do not want to compromise the lift at all!

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