Breast augmentation after weight loss - options for a natural, full look without a lift? (Photo)

Question

I‘m 33 yo and lost almost 50 kg last years and I‘m not pleased with how my body looks. I wanna start with my breasts which I want to look naturally full without a lift (I hate that scar). I‘d be grateful for your opinions.

Sean Hill, MD · Answer

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon – Lone Star Plastic Surgery (Frisco, TX):
First &mdash; congratulations on your weight loss. That’s an incredible accomplishment. What you’re experiencing now is very common after significant weight loss.
⸻

Daniel Barrett, MD · Answer

Dear Trustworthy348752,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Daryl K. Hoffman, MD · Answer

Losing a significant amount of weight is a wonderful accomplishment. Congratulations. Unfortunately, based on your photo, breast augmentation on its own will not result in the natural-looking, full breasts that you want. Breast implants add upper pole volume, but they can not eliminate the need for a breast lift. An experienced plastic surgeon will make precise incisions and provide incision-care instructions that will minimize the appearance of scars.

Ira H. Rex III, MD · Answer

It is difficult to make a good recommendation from your photograph.  Maybe you can take 1 at a better angle and submit it.  From what I can tell, I do not think you have many alternatives.  It seems like you have to do a lift with the required scars, or perhaps nothing.  I am not sure there is anything in between for you.  I think a consult with a plastic surgeon could give you a much better idea what the possibilities are after they do an exam.

Mehmet Ozdemir, MD · Answer

Huge congrats on that 50kg weight loss&mdash;that is an amazing feat of discipline! I totally get the "scar-phobia"; nobody actually wants more lines on their body. The tricky part is that after losing so much weight, the breast "envelope" is often a bit too large for the volume inside. If we just add an implant without a lift, it can sometimes look like a "ball in a sock," where the implant stays firm but the nipple still points downward. However, if your skin still has some decent elasticity, we might be able to get away with a crescent lift (just a small scar around the top of the nipple) or a larger, high-profile implant to "fill the space" and give you that rounded look you’re after. It’s all about finding that sweet spot where you get the fullness you want without a scar that bothers you. Let's talk about what's realistically possible for your specific frame!

Leila Kasrai, MD, FRCSC · Answer

Unfortunately, a lift would probably be your most suitable option since your nipples are located below your breast fold. Implants alone would not give you fullness in the upper portion of your breasts. A lift would reshape your breasts so that they are perkier and fuller.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
With regards to your specific question, addressing the changes that come with weight loss typically requires a multi prong approach. An augmentation addresses the loss of upper pole volume and the lift addresses shape and skin laxity. While both are not absolutely necessary, foregoing one or other will mean an aesthetic sacrifice. A lift does come with scars, however, without a lift there will be a disconnect between the implant mound and native breast.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Gary M. Horndeski, MD · Answer

Many women refuse lifts because of the vertical scars associated with the traditional techniques. For this reason, an alternative was developed called the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief and long term stability. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Jeffrey M. Darrow, MD · Answer

Thank you for your photo.  You have a Grade 2 ptosis and stretch marks on your breast skin.  You appear to have ample breast tissue.  Adding an implant will increase the weight of your breast and increase your ptosis. To elevate your nipple/areola to their correct position, create a fuller more lifted breast and reduce the size of your areola to its correct size would require a breast lift.  This would give you the naturally full look you seek.  I understand your concern about the lift incisions, however, meticulous closure of the lift incisions should make them very well camouflaged.  Have a detailed consultation with a plastic surgeon so you can understand your best option.  Best wishes.

George Marosan, MD · Answer

Thank you for your question and photo. You have low lying breasts and just placing implants to the superior pole will give you a waterfall deformity, If placing them lower behind the nipple/areolar complex will give you a "rock in the sock" deformity. The bottom line is that you need a breast lift +/- implants. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

Breast augmentation after weight loss - options for a natural, full look without a lift? (Photo)

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