Breast Augmentation: Cost, Reviews, Photos

Lift or not to?

From the photos it looks like your surgeon is right. Remember that the nipple is suppose to be across from the infra-mammary fold (fold behind the breast) . Additionally redundant skin looks like a concern. Also submuscular placement is my preferred location due to the natural slope of the breast with this position. But without examining you, it looks like a lift will be necessary. Is a peri-areolar vs a vertical component needed with the mastopexy depends on the physical exam. To keep you in a smaller size implant the skin will have to be addressed. (Paul Albear, MD, Tampa Plastic Surgeon)

Do I have to have a breast lift if I want implants?

In general, if the breasts appear droopy or sagging, you need a lift if you are having a breast augmentation. This will give the best possible result. For many reasons, including scars, some patients do not want to have a breast lift. You can always have a breast augmentation first, and if not pleased, have a breast lift later. A middle ground would be a breast augmentation with a periareolar lift (only a circle around the areola). (Frank Agullo, MD, El Paso Plastic Surgeon)

Is a breast lift a necesary adjunct to breast augmentation

After looking at your photos I agree with your surgeon that a breast lift is necessary. You never want to have to add a procedure unless it’s necessary which it is in your case. But I believe that in your case your only scar for the lifting will be around the areola which usually heals well. You do not need other scars.

The breast augmentation can also be done through this scar. Any you can go below the muscle. (George Lefkovits, MD, New York Plastic Surgeon)

Breast augmentation with breast lift

An examination is obviously necessary to determine what procedure would be ideal,but your pictures do seem to show a fair amount of breast sagging which would benefit from a lift in conjunction with your augmentation. The general rule of thumb is that when the nipple falls below the level of the inframammary fold a lift is required for optimum shape. If you are significantly concerned with the scars associated with the lift an augmentation could be done first and a lift secondarily if the shape were unacceptable. The thing you need to remember with this approach is that there is a reasonable chance a subsequent lift would be required for the best shape and you would have to be prepared for that possibility. (David A. Bottger, MD, Philadelphia Plastic Surgeon)

You would need a lift along with implants to give you what you are looking for. An implant by itself will still leave you hanging and but 450cc due to your anatomy and the amount of skin present. There are different methods of doing lifts however, and my preference would be a vertical lift that would uses an incision around the areola and up and down, like a lollipop. No one likes to have any scarring but you may be surprised that it may not be bad at all and well worth the improved shape that you will get. (David Nicholas Csikai, MD, Jacksonville Plastic Surgeon)

You would be best treated with a breast lift to correct the sagging and simultaneous implants to give you the upper pole fullness you want. You don’t have to be 450cc than you are now, but have the breast fullness where you want it. A lift alone does not restore upper pole fullness.

Implants alone do not correct sagging and you will be back for a lift. All lifts are not created equal. A periareolar lift is not a good operation, nor is an inverted-T. You would be best served with a vertical lift by a very experienced operator. (Eric Swanson, MD, Kansas City Plastic Surgeon)

It is possible to improve the appearance of your breast by adding moderate size implant with high profile (350-450cc implant) which is going to make your breast to become more perky and nipples to move up about quarter inch. However if you want to have a better result you should consider to have a donut Mastopexy (remove the donut of skin around your are lo which does not give you significant visible scars.

During this implants could be placed under your muscle. To see example of above operation you can visit our website and review the photo gallery. Look for augmentation with donut Mastopexy. (Fereydoon S. Mahjouri, MD, Minneapolis Plastic Surgeon)

I would definitely recommend a breast lift at the same time as a breast augmentation. In fact you may even get a better result if you did a breast lift alone, followed 6 months later by a breast implant. I would not recommend doing breast implants alone however – you will not be happy with your results.

You should consult with a few different plastic surgeons and I suspect all will agree a breast lift is needed based on your anatomy. (William Bruno, MD, Beverly Hills Plastic Surgeon)

Breast Augmentation/Lift: subglandular or submuscular

Many women struggle with the decision of whether or not to incorporate a breast lift (mastopexy) with their breast augmentation, in addition to the choice between under or over the muscle.

The concern of scarring and the ability to breast feed in the future are both legitimate concerns. I can assure you that when performed by a board certified plastic surgeon, the scars of a breast lift will heal very well, and are minimal the majority of the time.

Additionally the majority of my patients are able to breast feed after having a breast augmentation and lift.

The essential technique to ensure sensual and aesthetic results is to have the implants placed under the muscle and a lift performed to give you sensual perky sexy breasts that maintain their look. A subglandular implant with no lift will cause you to drop and stretch your breasts even more, and will have greater risk of affecting nursing in the future compared to submuscular approach.

When rejuvenating and augmenting the breast, the most important quality are to maximize shape, sensuality and symmetry to attain that amazing sexy and sensual result. (John G. Apostolides, MD, FACS, La Jolla Plastic Surgeon)

Great photo but in person always better. In that regard my recommendation is donut lift + under muscle implants. Follow up of results please. (Darryl J. Blinski, MD, Miami Plastic Surgeon)

Breast implants and ptosis

I hear what you are saying, but like many of my colleagues feel that 450cc subglandular implants will eventually sag due to the implant weight and skin laxity.

Subpectoral placement tends to be better for upper pole fullness and may be combined with a periareolar mastopexy if necessary. For narrow breast width, I frequently use moderate plus implants, rarely HP. Yes, after pregnancy a breast lift may be beneficial. (Michelle Zweifler, MD, New York Plastic Surgeon)

I agree with implants over the muscle, but unless you want to be large, I think that 450cc is on the big size for you. Perhaps you are 6″ tall and then I will change my mind. Best to be seen and evaluated. I am just guessing but do have over 30 years of experience behind me. (William B. Rosenblatt, MD, New York Plastic Surgeon)

Subglandular silicone breast implants work well for mild ptosis.

1. So many different opinions. You must be so confused. We are quick to recommend a lift in borderline situations, but judging by your pictures, you will do fine just with implants.
2. We don’t know your dimensions, but in general 450cc’s is quite large. The best thing to do is to use sterile implant sizers during surgery to see exactly (without guess work) which implants give you the best result. My guess would be ? 400 cc’s.
3. Do not use “moderate” profile implants, because they are under filled and can cause rippling. For most women, moderate PLUS profile implants are best. We use high profile implants when the base diameter of the breasts is narrower. It is not the profile of the implants that determines the fullness. You should get good upper pole fullness. (George J. Beraka, MD (retired), Manhattan Plastic Surgeon)

Breast Implant Positioning

I believe that you could have implants placed in a subectoral dual-plane or a subglandular pocket. While some subglandular augmentation patients have no problems, if you do have some of the problems stated below, these problems can be extremely difficult to correct later due to thinning out of your tissues. (Donald Griffin, MD, Nashville Plastic Surgeon)

450cc Subglandular Implants May Be Visible

First of all, I do feel that you can have a nice result with implants alone in the right hands. Your nipples appear to be above the inframammary fold. I would caution you, however, that a 450cc implant placed above your muscle may well become visible at its edges. (you do not seem to have much upper pole breast tissue). (John Whitt, MD (retired), Louisville Plastic Surgeon)

You DO NOT need a lift. Cold subfascial augmentation allows a supported natural tear drop appearance.

From your pictures it appears that you absolutely DO NOT need a lift. Your nipples are very close to the midhumeral point of your arm where they should be. You have a very high inframammary fold which can cause some confusion in this regard. I treat patients such as you with a technique that I call ‘cold-subfascial.’

I use a transaxillary approach so there are no scars on the breast nd because this technique actually supports the implant into a tear drop shape I use low profile implants. Low profile implants give a larger radius and allow more upper pole fullness. You appear to have a rather wide chest and would benifit from this strategy. (Rian A. Maercks, MD, Miami Plastic Surgeon)

The best plan right now if you don’t want a lift is to go submuscular and keep the size and profile as conservative as possible. Folks like you who try to fake a lift with big above the muscle implants wind up with some of the worst results after 10 years and the revisions are much more difficult because of the stretched out tissue. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)

Submuscular implant only and no lifting required

The submuscular position will look much more natural, less palpitable, and decrease the chance of implant migration and malposition in the future when compared with the placement of the implant on top of the muscle.

Further, looking at your pictures, I can identify that the nipple-areaola is in a perfect location (one centimeter above the fold under the breast), and thus no lifting required.

This is indeed very good news, as this avoids unnecessary scars on your breasts. I definitely agree with your decision about choosing silicone (softer/more natural). (Robert Morgan Davoudi, MD, Atlanta Plastic Surgeon)

Subglandular Breast Implants VS Breast Lift

To answer your question, let me present you with a few concepts

1. Everything sags with age and weight. Few things sag faster than heavy breasts.
2. If you want the breasts lifted, then you need to have a Breast Lift (Mastopexy). Adding volume (Breast Implant) to the breasts will result in MINIMAL lifting of the nipple complex followed by rapid sagging of the breast since breast implants add weight to the already sagging breasts and additional weight = heavier breasts= faster sagging.
3. Placing breast implants OVER the muscle better fills the breast skin envelope better than under the muscle creating the temporary lifting effect BUT they stretch out the lower half (pole) of the breast more andf result in quicker sagging.
4. A large silicone gel implant (such as a 450cc gel) HP gel implant would be a temporary compromise to fill the breasts and temporarilly lift them. Eventually you would require a implant exchange to an under the muscle postion with a formal breast lift. (Peter A. Aldea, MD, Memphis Plastic Surgeon)

I do not think that you are a candidate for augmentation alone from your photos and suspect that you will not be happy with the result. I certainly would not recommend placement above the muscle as you have very little breast mass and this will only speed up the sagging.

The larger the implant, the more likely the sagging so I think you have to consider the potential complications and need for revision. Paitents do very well with augment/pexy and I am always baffled as to why they think that they can have only part of the operation and be 1005 satisfied with the outcome. (Robert L. Kraft, MD, New York Plastic Surgeon)

Dilemma: Breast Lift or Augment

It really depends on the size and shape of the breast. If the breast is really lax and “saggy”, a breast lift or mastopexy may be the right option.

If the breast is not as large as you would like or it has lost its upper volume after breast feeding, augmentation may be the best option.

There are some patients who could benefit from a combination breast lift and augmentation as well.

The downside of a breast lift is that longer incisions are necessary with a potential scar around the edge of the areola and possibly underneath the breast, so scarring is a definite consideration.

The upside of the breast lift is that it can be done to reshape the breast and retighten the breast tissue closer to the chest wall which will create a nicer result for the right patient. You should ask your plastic surgeon for their thoughts and advice. (James Tang, MD, Houston Plastic Surgeon)

Breast augmentation or breast lift

You have to answer whether you want more volume or not. If you are happy with your current breast size but not happy with your shape because they are saggy, then you should get breast lift.

If you are not happy with your size, then you can get implants. If you are not happy with both the size and shape, then you will need breast augmentation and lift at the same time.

Please talk with your plastic surgeon about your goals and expectation. She or he will give you the recommendation based on your goals and your breast size/shape. (Miguel A. Yanez, MD, Charlotte Plastic Surgeon)

Breast lifting with or without implants vs implants alone

Basically, if you pad your bra and want more volume than you have, you need an implant regardless of the lift issue. If you want upper pole fullness, you also need an implant because a lift alone won’t usually do that.

You need a lift if the nipple areola has descended down from a youthful elevated position. Remember that the best looking breasts have the nipples on the front pointing forward. The farther down they have gone the more lift and scars you need. If they are still above the crease below the breast, often a lift just around the areola will be enough.

If the nipple is at the level of the lowest point of the crease or below that or is pointing down toward the floor, you need a full lift to get the best shape. Many examples are on the site below. (Michael Vincent, MD, Rockville Plastic Surgeon)

Choosing between breast augmentation, lift, or both

The decision to do augmentation is based primarily a desire to increase size/volume of the breast. If you feel that your breast is too small then breast augmentation is indicated. A breast lift is used to elevate or restore nipple and/or breast tissue to a more youthful position.

Typically by looking at mirror, if you are unhappy with where the nipple and/or breast tissue is located, then you can benefit from a breast lift procedure. There are several types of breast lift procedures depending on the position and shape of your nipple, amount of skin and severity of breast tissue sagging.

Sometimes, both augmentation and lift are necessary depending on your goals and wishes. This is where a face to face consultation with an experienced plastic surgeon is necessary to help you determine the best treatment option. (Michael Vincent, MD, Denver Plastic Surgeon)

Breast lift versus breast augmentation

Breast augmentation is designed to increase the volume (size) of your breasts. It does provide a small amount of lift to breasts that are slightly lower than their desired position. If you have drooping or “ptosis” of your breasts that significantly displaces your nipples downward, a breast lift may be a more appropriate operation. See your plastic surgeon for an in-person examination and evaluation. (Paul C. Zwiebel, MD, Houston Plastic Surgeon)

Breast lift and augmentation

There are many variables to think about here. The first is the patient’s wishes and what their goals are. Generally, if a patient wants more volume, an implant is required.

Also, if a patient will tolerate the scars, a mastopexy may be recommended if there is enough sag or laxity to the breast such that the breast is sliding off the chest or certain absolute lengths of skin are present for example from the nipple to the fold.

At the end of the day, it’s a judgement call, particularly when the breast is minimally ptotic, or in a gray zone, and discussing the options and trade offs with the patient is important to make a final recommendation. (Paul C. Zwiebel, MD, Houston Plastic Surgeon)