It depends on the results that you want. Fullness to the upper part of your breast (cleavage) is really only restored with an implant.
A breast lift (“mastopexy”) changes the shape and form of your breast. For optimal results you likely need both. if your expectation is for uplifted, fuller appearing breasts.
Implants alone will likely not give you the look you want.
Again, seeing a board certified plastic surgeon (American Board of Plastic Surgery) in consultation is an important part of the decision making process. (Christopher Killingsworth, MD, Atlanta Plastic Surgeon)
No good Plastic Surgeon will recommend treatment without examining you.
But, from the picture I can tell you that if you just have implant you are going to get large saggy breasts. If size is all you want then it may be a possibility. But,if you want large and nice looking breasts you need to consider Breast Lift as well. Your best bet is to see an experienced Board Certified Plastic Surgeon and discuss the issues in person. (Suman K. Das, MD, Jackson Plastic Surgeon)
Many women are in the same exact situation as you, so by sharing your photos you’re not only helping yourself, but you’re also helping many other women! It’s very important for me as a plastic surgeon to examine a patient (and have a thorough conversation with her) before suggesting a procedure for her. Based on these photos, it seems like a breast lift may be helpful for you. However, it also heavily depends on YOUR goals and YOUR desires, as well as your exam. So I strongly suggest visiting with at least 2 board certified plastic surgeons to discuss your goals with them before coming to a decision. (James Knoetgen, III, MD, Fresno Plastic Surgeon
Based on your pictures, it does appear that you would benefit from a lift. If a lift is not performed at the same time as an augmentation, you will likely have implants that sag if placed above the muscle or an implant that sits higher on your chest than your breast if placed under the muscle. Make sure you visit with a board-certified plastic surgeon in person. (Naveen Setty, MD, Dallas Plastic Surgeon)
Based on your progression photos you have a moderate case of pitosis (Saggy breast) and you are a peret candidate of a breast augmentation , choosing the correct size of implants (Wall frame dimentions) to achive your goals. I always tell to my patients that an augmentation without a lift will create a larger sagging breast, also will make the sagging look worse. You will certainly be disappointed if you do not have a lift. (Manuel Marte, MD, Dominican Republic Plastic Surgeon)
Breast Augmentation with or without a lift
From progression photos, it appears that you could possibly have augmentation without a lift, but it would ultimately depend on your measurements and a thorough examination. The need for a breast lift depends on your nipple position, and breast implants placed under your pectoral muscles can give you the fullness that you have lost. I hope this helps in your decision in moving forward with surgery. (Mark E. Mason, MD, Dallas Plastic Surgeon)
You have sagging even when you lifted your arms to take your photos and breasts moved up. Sagging would have been worse if you were not raising your arms. If you get implants without breast lift you will get large heavy sagging breasts. That is not a good look. You need breast lift and implants. Lift is a must. Implants are optional. (Vasdev Rai, MD, Dallas Plastic Surgeon)
It appears that a breast augmentation and mastopexy (breast lift) will be necessary to achieve the results that you desire. Do seek a board certified plastic surgeon to discuss your options. (Jeremy A. Benedetti, MD, Tampa Plastic Surgeon)
Implants don’t lift the breasts. Implants re-inflate the breasts. Implants contribute to shaping the breasts by adding volume. Based on progression photos, you do have sagging, not just volume loss.
If you opt for implants alone, you will have larger saggy breasts (Paul C. Zwiebel, MD, Denver Plastic Surgeon)
It appears that you are a candidate for a breast lift. Implants will only address the volume and not the shape of your breasts. (Thomas Trevisani, Sr., MD, Orlando Plastic Surgeon)
There is no perfect answer in plastic surgery. It really comes down to pros and cons. Based on your photos I think that there would be a benefit to doing a breast lift (mastopexy) in addition to the breast augmentation.
I think you have a bit too much ptosis (droop). Even with your arms elevated which improves shape. To be happy with just an augmentation. The trade off is added scars. However, well done scars fade away and you will have much better shape and a more beautiful result. I would discuss this with your plastic surgeon. (Rodger Shortt, FRCSC, Toronto Plastic Surgeon)
A breast augmentation alone does not produce a significant lift. It looks like in some progression photos, that you need a lift. Best to be seen in person to be sure. (Steven Wallach, MD, Manhattan Plastic Surgeon)
Judging by progression photos, you would probably do best with a lift and enlargement. You could just have an augmentation with gel implants behind the breast tissue. This will give you a larger breast, but your nipples will not be raised, and you might not have as much fullness in the top of the breasts. I would suggest meeting with a board certified plastic surgeon and discuss all your concerns. (Connie Hiers, MD, San Antonio Plastic Surgeon)
I think you would be very unhappy with an implant alone. Likely, the implant and breast tissue would be in two different locations. The implant would sit in the proper position but the breast tissue would be drooping. So, the best choice for you would be an augmentation mastopexy. The scar would be around your areola and down towards the under fold of the breast. Like a lollipop. (Justin Yovino, MD, FACS, Beverly Hills Plastic Surgeon)
It is possible to place implants without a lift. An in person evaluation can give you a better idea. (Karol A. Gutowski, MD, FACS, Chicago Plastic Surgeon)
From your pictures it appears you would likely be unhappy with the result from a breast augmentation alone. If an implant is placed in a breast with moderate droop, it gives the appearance of tissue sagging over the front of the implant. Breast implants address volume, a breast lift addresses nipple placement and shape. (Mary Lee Peters, MD, Seattle Plastic Surgeon)
Probably not what you want to hear, but I wouldn’t perform an augmentation without a lift in a patient with your anatomy. The implant will not alter the nipple position much in the vertical dimension, only the projection. It just wouldn’t look right and it is unlikely that you would be happy. (Earl E. Ferguson III, MD, FACS, San Antonio Plastic Surgeon)
I would suggest a lift to improve the 3dimensional shape of your breast, you could have fat transfer (using the fat from liposuction) and spare the implant to have a natural lift and augmentation (Ryan Neinstein, MD, FRCSC, New York Plastic Surgeon)
From you pictures, you appear to be a B cup with level 2 ptosis, large areolas and significant hang of lower pole. With your breasts shape, augmentation alone will be less than optimal and I would not recommend it. As a matter of fact, your saggyness will get worse and your areola’s size will increase significantly. A full lift ( key hole ) will give you a beautiful perky breasts with more attractive , smaller areolas. You did not provide your chest circumferemce measurement, so let’s assume that you are 38 B cup. 38 full C cup will give you a very attractive and faminine breasts. To get to that size, you will need implants with volume of, roughly, 300 cc. Finally, the scars fade off with time and are a very good trade off for beautiful breasts. Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures to make sure that they are numerous, consistent and attractive. Check also the ‘realself’ for positive patients experience which provides important information on the surgeons. (Shlomo Widder, MD, Washington DC Plastic Surgeon)
Augmentation with Lift
To obtain the optimal result from a breast augmentation, I would advise you to also have a breast lift. By reviewing your progression photos, there is a sufficient amount of sagging that could be dramatically reduced by opting to have both procedures done together. Be sure to schedule a consultation with a Board Certified Plastic Surgeon, and he or she will answer any questions you may have about this procedure. (Evan Manolis, MD, Orland Park Plastic Surgeon)
Simply put if your nipple falls below the bottom of the breast (inframammary crease) you would benefit from a lift. Your progression photos appear to confirm that (Frederic H. Corbin, MD, Brea Plastic Surgeon)
I think an implant will certainly make you larger, but due to the shape of your breast, you will just be bigger and still saggy. You will likely have the rounded upper part of the mound for a few months and then it will take the more natural sloped appearance due to the laxity of your skin (Julio Garcia, MD, Las Vegas Plastic Surgeon)
From the evaluation of your photos you have a good deal of sagging especially in the first photo where your arms are up. The sagginess is not helped by raising your arms.
I think you will need a lift as well as an implant to obtain an optimal result. I don’t think you would be happy with only a lift. (Thomas Guillot, MD, Baton Rouge Plastic Surgeon)
Looking at your progression photos it appears that you are in need of a breast lift, without which you will not get a good result. You have definite sagging of the breasts. (George Lefkovits, MD, New York Plastic Surgeon)
Breast Augmentation with or without a lift
If you were my patient I would recommend a lift. I see many doctors are giving you reasons why a lift is important in your situation. I would emphasize that shape is the most important feature which make a breast attractive, followed by symmetry. Size follows. (Vishnu Rumalla, MD, Dallas Plastic Surgeon)
The implant will give you the volume, but you need the lift to give you the form. Otherwise you go from smaller sagging breasts to larger sagging breasts. You are wise to consider all your options. (Scott W. Vann, MD, FACS, Savannah Plastic Surgeon)
It appears that you have significant ptosis or sagging of your breasts as both nipples lie well below your inframmmary fold (breast crease). Implants alone will only accentuate the ptosis and detract from your breast shape. You appear to also need a breast lift but that decision is one you need to make with your board certified plastic surgeon who has the advantage of seeing you in person. (Richard Chaffoo, MD, FACS, San Diego Plastic Surgeon)
Breast augmentation without a lift
As the others have said, from the look of progression photos, implants alone will give you large bottom heavy saggy breasts. You can always do the implants and see if you’re okay with the look, but don’t expect magic and expect to need a lift later. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
I believe you absolutely need a lift. Although your nipples are pointing outward (not down), your breasts are too low on your chest. If you simply put implants in your breasts where they are now, they will just be bigger, but LOWER. Do the right procedure at the outset. To try and avoid a lift right now will only bring you back to the OR in the very near future for a more difficult case to lift them after your tissue has stretched even more. (Holly Casey Wall, MD, FACS, Shreveport Plastic Surgeon)