I'm a very saggy 36DDD+. I want full D's-DDs with upper pole fullness. Is it safe to do implants w/ reduction/lift or do I wait?

I have A) one highly qualified PS that says do the BR/BL & small implant at the same time. He has many good photos of this procedure & does it often. I also have B) another highly qualified PS that says do the BL/BR in 1 surgery & the implant 6mths-12mths after. He says it's too dangerous & I will likely need revisions if done together. I can't decide if Dr. A is a "better""more innovative" Dr. that is more qualified for what I need or if I should go with Dr. B because he's being more cautious?

Doctor Answers 12

Creating Upper Breast Fullness with Breast Lift/Reduction

Breast lifts and reductions can reliably lift the central and lower breast tissue upward to correct sagging, leaving the central breast full and the nipples at a good level.  However, neither a breast lift or reduction (or combination of the two) can reliably create long-lasting upper breast fullness, above the nipples.  To achieve that upper "pole" fullness in the cleavage area, you need a breast implant.  This can be safely done at the time of a breast lift/reduction.  If you actually want to remain pretty much the same size, or slightly smaller, then the surgeon must remove enough of your own breast tissue, so that the addition of the implant size will leave you at your desired size.  I call this the "minus-plus" mastopexy (breast lift), since saggy breast tissue is being removed (minus) and then upper breast size is then increased with an implant (plus).  This technique is becoming more and more popular today.

West Palm Beach Plastic Surgeon
5.0 out of 5 stars 30 reviews

Breast Reduction with implants - the risks.

A breast reduction performed at the same time as an augmentation is commonly done when the desire is to be smaller but to maintain upper pole breast fullness. Breast lifts and reductions rarely maintain round fullness in the upper pole beyond 3-6 months. To achieve long standing fullness in the upper pole, the use of small implants in a sub muscular position (under the pectorals muscle) works wonders.  Depending upon the type of reduction performed, this is a very safe procedure. This is in contrast to a traditional breast lift with implants. An "augmentation mastopexy" (lift with implants) may use large implants and large skin excisions which can put the blood supply to the nipple at risk. As for who you should go with? I would need to see you in person to determine whether or not its safe for you to have both procedures at once. When in doubt between two surgeons, see a third.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

The right size for you

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.
See the below link on some suggestions on finding the most qualified Plastic Surgeon for breast implants.

It 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 below link.


Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Breast lift with implants

Thank you for your question.  Unfortunately without photos or more importantly, an in-person evaluation, it is nearly impossible to tell you what would be best for you.  However, I recommend that you ensure both surgeons are board-certified in plastic surgery and are experts in the breast lift/augmentation procedures.  Look at their before and after photos to confirm this.  It could be possible that given the amount of breast tissue you currently have, you could be a candidate for what I call "the natural" breast lift which uses your own tissue (no implant) to give your breasts an improved appearance.  I advise against using an implant that is too large as it can "undo" the results of your lift.

Best of luck!

Jose M. Soler-Baillo, MD
Miami Plastic Surgeon
4.7 out of 5 stars 92 reviews


You have ample breast tissue and should not need additional volume supplied by an implant.  I would recommend a vertical lift, using your own tissue to augment the upper pole without the use of an implant.  You should get a nice result with the volume you desire. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Breast reduction with implants

Hello and thanks. Breast reduction with implants at one surgical setting is an excellent option in appropriate patients because the small implant can provide upper pole fullness more reliably  than a reduction and breast lift. The advantage is one surgery and one recovery.  If you're hesitant may have the procedures staged.  Choose the surgeon that you trust the most.


Carlos Burnett, MD, FACS
Westfield Plastic Surgeon
4.9 out of 5 stars 37 reviews

Reduction and Implants?

Photo submission would be very helpful.  Cup size varies with different bra manufacturers.  Breast tissue density varies with different patients.  If a patient has good upper pole fullness, I generally try to avoid an implant with the reduction, and instead depend on the patients own tissue.  If the patient has less dense breast tissue, and less upper pole fullness, than I would consider an implant at the same time.

Joshua Lampert, MD,FACS
Miami Plastic Surgeon
5.0 out of 5 stars 27 reviews

I'm a very saggy 36DDD+. I want full D's-DDs with upper pole fullness. Is it safe to do implants w/ reduction/lift or do I wait?

Without photos and the benefit of physical exam-it's difficult to comment accurately. It sounds as though you are a candidate for a reduction/lift procedure. Only in person exam by an experienced Board Certified PS will help you make your decision. 

Thomas Trevisani, Sr., MD
Orlando Plastic Surgeon
4.9 out of 5 stars 63 reviews

Breast reduction, some advices:

Thank you very much for sharing your concerns with us.
After having analyzed all the information provided to us, i can realize that you have very large breasts for your height and weight, and can be responsible for head, back, neck and shoulder pain.
In the future may cause permanent osteo-articular damage in the back and shoulders and skin problems (mainly under the breasts). For for this reasons, certainly you need a breast reduction surgery.
Kind regards,
Dr. Emmanuel Mallol.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 252 reviews

I'm a very saggy 36DDD+. I want full D's-DDs with upper pole fullness. Is it safe to do implants w/ reduction/lift or do I wait?

You have very large breasts. A breast reduction is much more extensive surgery than a simple breast lift./ Because the reduction is more extensive there will be more tissue damage and disturbance of blood flow to the nipple.

Because of these factoirs I would choose a staged procedure. The risk of a one stage procedure is nipple loss.

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.