Want a breast augmentation. Would a lift be necessary also? (photos)

Hello and thank you for your question. Based on your photographs I would highly recommend doing a breast lift with your desired augmentation. The reason for that is the degree of sagging to the breast that is currently evident on your photographs. If you were only to do a breast augmentation the rest of the breast would sag on top of the implant and this would create a cosmetic deformity that is not pleasing to the eye. By doing a breast lift at the same time as the augmentation you get better upper breast fullness and much better positioning of the areole. Currently there is too much sagging to recommend a breast augmentation alone.
Alex Zuriarrain, MD, FACSQuadruple Board-Certified Plastic/Cosmetic SurgeonCleveland Clinic Trained

Hi& thanks for your question!
Based on your photo you would need a breast lift and placement of implants. Schedule a consultation with a board certified plastic surgeon to discuss your options. Best wishes!

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They then get to choose what looks right for them. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Viewing your photos, I believe you would get the best result with a augmentation/mastopexy with an anchor incision. This incision would go around the areola, vertically below and then along the crease of the breast. A circumareolar lift would not be sufficient for your level of ptosis. I would recommend scheduling a consult with a board certified surgeon to discuss your options. With the proper surgery, I believe you could achieve a very beautiful result that you would be thrilled with. Best wishes!

You will definitely need a lift. Further, a circumareolar lift would be a disaster because your breasts are too big, too saggy. Fear not the dreaded vertical scar; it's the one scar that will become virtually invisible over time. But most importantly, the vertical scar is necessary to achieve a true lift and repositioning of the nipple areolar complex.

The technique I recommend is a lift using The Bellesoma Method. 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. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Dear Ccblaa2022,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

An examination in person would be required to properly advise you specifically. However, based on your photos it would be ill-advised to undergo a breast augmentation. You appear to have an adequate amount of breast volume, and the vast majority of women who present with a D-cup breast require either a mastopexy (breast lift) or breast reduction, but certainly not an augmentation. You indeed appear to be a excellent candidate for a breast lift and unfortunately, the circumareolar mastopexy would not accomplish your aesthetic goals. Most of the laxity in your breasts is related to the excess skin in the vertical dimension, and the distance from the bottom of your breast to the nipple need to be shortened, along with elevation of your nipple to a point higher on your chest. It is possible that a small implant might be required to give you the desired amount of overall volume and upper pole fullness you desire, but the implant would need to be of adequate width, and not large in either volume of projection, neither of which are deficient in your case.

Do your research, and select a board certified plastic surgeon whose results on his or her Before and After gallery appeal to you. Best of luck to you.

In my opinion you need a mastopexy (breast lift), this is never scarless, there is no scarless breast lift. A periareolar lift won't be enough and still leaves scars. I personally would try to discourage you from an implant, I think the long term results would be recurrence of the droop. If you do proceed with augmentation please see a surgeon who has experience with augmenting large breasts and can show you photos of results that would be similar to yours. Good luck, Jane.

Thank you for sharing your question and photographs.  It appears that you would most benefit from implant placement and a lift.  The implant will help add breast volume, while the lift will remove excess skin and allow for resizing and repositioning of your nipple into a higher, more youthful, position.  Hope this helps