Breast lift and augmentation? Or just implants? (photos)

I lost a drastic amount of weight over the period of one year (2013) and my breasts were left sagging. I've wanted a breast lift since. Finally took my first step today and had a consultation at Harley Street Medical Centre, their Maidstone clinic. The lady who I had my consult with said she doesn't think I need a lift, just implants. However, I have been doing a lot of research and have read that implants and stretched skin will just make the situation worse. Any other professional opinions?

Doctor Answers 6

Implants and lift candidate, some advices:

Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 400-450ml will be excelent on you, to fill the breasts properly.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Respectfully,
Dr. Emmanuel Mallol Cotes.-


Dominican Republic Plastic Surgeon
4.7 out of 5 stars 178 reviews

Breast lift and augmentation? Or just implants?

Thank you for the question and pictures. Your pictures clearly demonstrate significant breast ptosis. As you stated, you will benefit from breast augmentation and lifting surgery.   You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.



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.



 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.  The attached link may also be helpful.   

Best wishes.

Surgery options

From these photos, you will need to be seen in person to determine if a lift is necessary. Please seek an in person consultation with a board certified plastic surgeon in your area. Be sure to express your goals and expectations to your chosen surgeon. In my practice in the San Francisco Bay Area I have come to the conclusion that the happiest patients are those that have realistic expectation on what a procedure will and won’t do for them. Good luck!

Dean Vistnes, MD. 

Vistnes Plastic Surgery

San Francisco Bay Area

#realself #drdeanvistnes #breastlift #breastaugmentation

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 42 reviews

Breast augmentation with or without mastopexy

Thank you for your question and photos.

You have Grade 3 ptosis, meaning that the nipples are nearly at the bottom of your breasts. It is unlikely that implants alone will correct this, and I would recommend a lift as well as implants for best cosmetic results. Best of luck!

Shady Hayek, MD
Lebanon Plastic Surgeon
5.0 out of 5 stars 11 reviews

To Lift or Not To Lift? That is the question!!

First of all congratulations on loosing the weight antd hank you for sharing your photos. They are very helpful. I feel a Breast Lift with Implants is your best option. You have lost volume because of your weight loss, and your nipple/areolae position is also low. Implant placement alone will not correct your nipple position. You are also correct that large or heaving implants on stretched skin can produce ptosis (saggyness) in the near future.

In my opinion a breast lift with the correct size implant will give you the size and fulness you are looking for as well as repositioning your nipple. In some cases a small lift such as a Donut Lift might be enough when using larger implants. Without an in-person examination it is hard to say, but I would assume that by choosing a not so small implant we can achieve excellent results with a Lollipop Lift or a J Lift. Be sure to contact other Plastic Surgeons on your journey before you make your decision. 

Best of luck on your journey!

Dr. Miguel Mota

Miguel Mota, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 31 reviews

Breast lift with implants, or just implants?

Dear CrissyDee

Many thanks for posting your question. As someone who has lost a lot of weight it is important to take the effect this will have had on your tissues into account in your decision making. 

By definition, your tissues have been stretched and have lost support - hence the droop and low nipple position. 

From what I can see from  your photographs, you would be an ideal candidate for a small implant combined with a breast lift - this will naturally enhance your breasts and reshape them, as well as lifting your nipples to a better position. Implants have a weight to them, so I would avoid a large implant as this will place stress on your already stretched tissues.

I hope this is of some help - if in doubt, I would recommend a second opinion from a fully accredited plastic surgeon.

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.