Lift or Implant exchange? (Photo)

Question

I am 5’4” 145lbs. Recently lost 50 lbs. Currenlty have saline implants under the muscle that are 20 years old. I want a little more volume but natural fullness and am concerned with loose skin and low nipple placement Dr. Suggested capsulectomy and repositioning a new pocket behind nipples will achieve look without lift scars. I really don’t want the scars. I’m not looking for cleaveage but am afraid this will still look toosaggy if I am to go braless in a shirt. What would you recommend

Gary M. Horndeski, MD · Answer

If you feel your breasts are low now then adding larger implants will make the situation worse. Also, in your frontal view, your breasts are widely separated. The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated 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 if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear cboobsp,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

First, placing implants over the muscle is not a great idea (palpable/visible implants with ripples, higher risk of capsular contracture), and implants placed over the muscle does not do what every woman wants who has low nipples or breast tissue: raise them to an appropriate position on the breast mound. Second, your tissues are poorly elastic and will not support the large and high profile device this surgeon is likely to recommend. He either doesn't know how to perform a breast lift or is simply just willing to take your money because it's easier to make the sale rather than inform you about the realities of your situation and possibly scare you away... to another doc who will do the same thing. You are now properly informed. Breast lift scars on your skin will be inconspicuous and the results unmatchable. Find a breast expert who will do the right thing for you.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I have been in practice almost 30 years and a large portion my practice is dedicated to breast revision surgery. I definitely would not lower your breast to match your nipples as you will have a very unattractive appearing breast.  I would recommend performing reaugmentation with a slightly larger implant with pocket modification and performing a breast lift-lollipop.  You should be able to have an excellent result.  I would consider seeing a different surgeon than the one that suggested this to you.  Best wishes to you.

Connie Hiers, MD, FACS · Answer

I would suggest the peri-areolar lift since your nipples and some breast tissue is sagging and go with a little larger implant for better fullness. Keep them behind the muscle.

Lift or Implant exchange? (Photo)

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