I want a lift and larger breasts: Which procedure should I get to minimize scarring and future sagging? (Photo)

     I have a lot of patients and many African American patients.  Even though I try to minimize scar in every instance, it does not make sense to sacrifice shape and overall appearance of the breasts to reduce the scar.  In your case, an implant placed under the muscle with a lollipop lift will produce a stable result that will not result in enlarged areolae or residual droop.Kenneth Hughes, MDLos Angeles, CA

Thanks for your question and pictures.  Placing an implant above the muscle to "lift" the breast is a mistake that is frequently made.  Usually, the implant is larger than what is desired because it needs to fill out the loose skin.  The initial results may look good but large implants carry lots of risks and the already loose skin gets stretched out quickly.  A properly done lift along with a conservative augmentation will give a much nicer look.  In my hands, I prefer a vertical lift as I do not feel enough is gained with a peri-areolar lift.

The periareolar lift typically does not change the breast shape much. It can elevate the nipple-areolar-complex to some extent, but it does not lift the breast. It also can flatten the shape of the breast some which is generally not anyone's goal. If you want to improve your breast shape and minimize future "sagging", I would suggest some type of lift that necessitates a vertical scar under the nipple. Even though this sounds like more scarring than the periareolar lift, the scars heal better and are less likely to widen. If you also want more volume in the upper portion of your breast, I would suggest a conservative sized breast implant placed under the muscle.

Thank you for your question. Breast implants will add volume and a breast lift will make you perky.  Most often scars fade in time even in African American patients.  Without a lift, the breast implants tend to sag into the extra skin and become droopy again.Discuss this in detail with your plastic surgeon.  I hope this helps.

I think of these two procedures as producing two specific goals in the same breast. I think of the breast lift as being in charge of lifting the lower half of the breast and repositioning the nipple and areola.  This provides a very natural breast shape. I think of an implant as filling and rounding out the top half of the breast.Looking at your photos, I just do not think an implant alone, without being an exceptionally big implant, will do the job. Exceptionally big implants have lots of problems down the line and are best avoided in most cases.  A reasonably large implant coupled with a lift is likely to give you a much more natural and aesthetic breast.The type of lift depends upon the surgeon's experience, expertise and opinion. In my experience, both in my practice and in other physicians results that I have seen, the periareolar lift is unsatisfying. The nipple scar is under tension and tends to look obvious, frequently spreading and needing to be redone in time. When that incision is carried down the front of the breast, the tension is redistributed and the breast tissue reshaped, allowing the reshaped breast tissue to provide a great shape rather than the skin around the areola.Best,Dr. Pyle

placing your breast implants beneath the breast on top of the muscle can result in more sagging of your breast.  For many reasons sub-muscular breast implantation is preferred and in your case a combination breast lift and sub-muscular implant is most likely your best option.  You may need a vertical scar to achieve the best breast shape.  Please consult a board certified plastic surgeon.