Breast Lift with Implants
Thank you for your question and for sharing pictures. You seem to be a good candidate for a breast lift with implants. This procedure will allow you to address your nipple size, as well as reshape your breasts. Implants will provide volume. I would recommend undergoing Vectra 3D Imaging to get an idea of your post procedural results with different types and sizes of implants. Breast of luck!
Augmentation without lift
The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.
HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.
The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.
The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.
Do I need a lift along with an augmentation or can I just have an augmentation?
Thank you for your question. Because you have a breast asymmetry and because you want your areola reduced a combination breast lift with subpectoral implants will likely be her best option. Please choose an experienced board certified plastic surgeon and otherwise have to consults to compare.
Do I need a lift along with an augmentation or can I just have an augmentation
I think that with a bra on and implants alone, you would look pretty close to your desired photo. With a bra on, I think your new breasts would sit lower on your rib cage and not look as close to the desired photos.
Lift is Usually Best with Implants
If your breasts are sagging with the nipple at or below your fold, a mastopexy is usually required. Implants with no lift is usually a mistake. Most breasts will look larger and more droopy. They will sag more and sooner because of the excess weight. The shape will usually not be satisfactory. There will sometimes be a “Snoopy” breast or double bubble. If the nipples is in a fairly high position on the breast or “glandular” ptosis or drooping , an implant may be useful.If you want more detail as to your procedure options and what would be the best for your specific case, be sure to take all questions with you to a local certified plastic surgeon in a consultation. It will be easy to determine what will provide the best results for what you desire. Best of luck!
Do I need a lift along with an augmentation or can I just have an augmentation?
Thank you for your question. Implants alone cannot center your nipples or reduce the size of your areolas. This would require a limited breast lift, likely a donut (circum-areolar) lift. Be sure to consult with an experienced board certified plastic surgeon. Good luck!
Obviously you will need to stop breast feeding first. You might need a small areola reduction along with the breast augmentation. Good luck.
Breast augmentation 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.
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".
Dr. Emmanuel Mallol Cotes.-
It looks like you could probably get by with just an implant if you just wanted your breasts larger. However you want your nipple centered, your areola smaller, and full breast without bra. To do this I think you will need a lift with your implant. All this might change when you stop breast feeding. Once you are done, consult with a plastic surgeon who does a lot of lifts. Good luck.
Must wait and see what you look like after breast feeding
I would guess that you will need some form of lift and areola reduction. Right now since you are breast feeding we really have no idea what your breasts will look like when you are done breast feeding. The Pic you like seems reasonable but I doubt she has breastfed children which as you know changes a lot. Good luck!