Just Want to Fill Up Breast Tissue. Not Worried About Perk. Is It Possible to Have Just an Augmentation? (photo)

I'm a 36 A. Want to be 36 C or small D. My measurements from clavicle to nipple (right breast 21; Left 20 cm); from inferior areola line to crease around 8 cm both breast. Around 13 cm across each breast. Looking for a natural look. Don't mind a little sag. Want smooth, round, mod to mod plus profile, under the muscle. Really want to avoid doing any type of lift. Is this possible? If so what size implant would I need? Can I avoid double bubble with my sag?

Doctor Answers 18

Just Want to Fill Up Breast Tissue. Not Worried About Perk. Is It Possible to Have Just an Augmentation? (photo)

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With the information you have provided I do think it is possible for you to have implants alone.  I have many patients in my own practice with the exact concerns that you have. Implant size is hard to guess, and that is all any of us would be doing on this website. I use implant sizers on the table first before choosing a final implant. You will likely need a moderate plus or high profile implant below the muscle. As long as you realize you will will have some drooping of the breasts and not perky breasts higher on your chest wall you can achieve your goals. You seem to have the type of droop where the nipple is in the normal position at the same line as your breast fold, but the breast tissue is below the fold, called pseudoptosis. Talk to your surgeon about a technique first described in 2001 in the Plastic and Reconstructive Surgery Journal titled: Dual Plane Breast Augmentation: Optimizing Implant-Soft-Tissue Realationships in a Wide Range of Breast Types" by John Tebbetts. He is a well respected excellent Plastic Surgeon in Dallas Texas and I use the techniques he describes in this paper with great success all the time. I think you are the perfect candidate for using this technique in a patient who is borderline for a lift and would like to avoid it.

Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Breast augmentation, vs augmentation plus lift.

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Breast lift or mastopexy, is done for one or a combination of two goals:

  • Reposition the nipple and areola
  • Remove excess skin

I see some excess skin, but an areola that is close to its "normal" position, An implant alone will fill in the excess skin, removing that indication for a lift. SInce the nipple and areola are positioned appropriately, I don't see the need for a lift. 

Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Dual Plane Placement

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The test we use for implant placement/lifts etc...is the position of the areola and does it sit below the fold. Your fold is tucked up, making your breasts appear lower. In my opinion, I don't feel "submuscular" is an ideal option for you. The shape of the breasts won't look right because the implants will sit higher than your breasts. However, partially under the muscle (dual plane) will be a nice compromise/option for you. You'll have the benefit of the muscle on the top part of the implant and fill out the bottom part of the breasts, creating a beautiful shape. 

To lift or not to lift?

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Thank you for the photos and questions.  Though you have some droop of your breast below the breast fold ("psuedoptosis"), you do not need a lift.  Implants will be all you need to give you fullness and a natual look.  If you are set on going under the pectoral muscle, then you could get saline or silicone.  Just beware that implants under the muscle will animate when you flex your chest muscles.  If you work out your chest muscles (even if it's just yoga or Pilates), over time, your implants will drift apart and downward.  If those side effects of under the muscle placement are bothersome to you, then have your implants placed above the muscle.  For above muscle placement, only use silicone gel implants.  The saline implants have a high risk of visible rippling.  As far as size goes, you and your surgeon need to discuss this in detail so at the end of the day, you are pleased with the way you look.  If you look on my website, there is lots of information about breast implants in a question and answer format.  There are also good before and after photos you can see.  Hope this helps.

Implant Selection Process

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If you choose not to have a lift, I would go with a dual plane approach.   In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Is a breast lift needed?

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From your photos, the best result would come from a breast lift and implant. However, it is possible that you can increase the volume alone with success, if you are not looking for a "perky" breast. This is a personal decision, but will not leave you with the "ideal outcome." Sometimes, this is enough to make a patient happy, which is the ultimate goal with this surgery.

You should see a board certified plastic surgeon in your area to get a formal opinion through and in-person consultation.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Ultimate Breast Lift a better option for sagging breasts

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Hello and thank you for your photos.

Women like yourself no longer need to fear the horrible scars left by the standard lifts. The Ultimate Breast Lift series is a new proprietary technique that successfully lifts breasts without a vertical scar. In your case, since you desire implants, I would perform a Mini UBL to reposition your breast tissue to avoid the 'double-bubble' effect. I would use a small saline or silicone submuscular implant, since you have plenty of natural breast tissue. Remember, large implants are heavy and will stretch tissue regardless of where they are placed. Please do not let anyone mislead you by saying that a large implant will 'take up the slack'. This is further from the truth. Trust me, I know because I made the same mistake for years.

I hope this helps.

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Is It Possible to Have Just an Augmentation?

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I think first you need to decide what size increase you would like to have then go from there. The larger size of implant you are comfortable "wearing" the more the breast skin will be filled and the rounder your breasts will look. The incisions for a BA are small, especially if you go with saline. The lift incisions are more extensive and remember - a scar is forever. You can always return for a lift later if you are not satisfied with your shape with the BA alone.

Brett Edward Lehocky, MD
Bakersfield Plastic Surgeon

How to Avoid Double Bubble With Breast Implants

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Without taking measurements it is difficult to tell exactly which treatment plan is best for you, but it looks like you could have positive results with sub-muscular implants without a lift. To avoid double bubble, the surgeon should not lift the inframammary fold. Also, an internal lift uses sutures to attach inner tissue to the pectoralis major which raises the nipples. This procedure leaves the patient with no scar and is a viable option to avoid double bubble. I would also recommend a dual plane augmentation.

If the double bubble occurs, the issue can be addressed through the use of fat grafting. The use of a board certified plastic surgeon is the best way to ensure the results that you hope for and avoiding complication.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

Breast lift or just augmentation

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A circumareola lift to lift some of the skin from the lower pole may help.  A vertical may be better. But if you jsut want implants the volume would be filled a bit.  It is a discusion ion person to better understand your goals and explain the realistic potential results.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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.