Women with a small degree of drooping can be served well with a crescent mastopexy where a semi-lunar shape of skin is removed from above the nipple to reposition the nipple on the breast. The implant can be placed through the same incision. If you do not have some form of lift, the nipple droop is only magnified. (Christopher J. Kovanda, MD, Minneapolis Plastic Surgeon)
Your nipple appears to be located above the level of the inframammary fold.
Generally this means that a breast lift is not necessary. However, you have what appears to be a little bit of upper pole skin excess (slightly hanging breast) as a result of your weight-loss, your nipple position is a bit low on the breast, and you have a bit of nipple-areolar complex asymmetry.
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In addition, it appears you have a well-defined inframammary crease. You can likely get away without a breast lift, but your need for a breast lift may depend upon the breast implant volume.
The larger the breast implant, the less likely it is that you will require a lift. However, large implants are associated with significant morbidity (skin thinning, breast gland atrophy, drooping, rippling, etc.), and I personally never recommend them.
In addition, a large implant will result in a need to lower the inframammary crease, and if the inframammary crease is well-defined, you may be at higher risk for a double-bubble deformity.
A dual-plane technique with a slight release of the pectoralis major muscle, may allow better interaction of the implant with the posterior surface of the breast tissue, and obviate the need for a breast lift.
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If you did require a breast lift, a periareolar approach would likely be all that is necessary. This would leave a circular scar around the outer border of the nipple-areolar complex that usually heals well. A periareolar skin tightening/lift would allow a slight reduction in the diameter of the nipple-areola complex to provide better balance with the breast size, and will allow you to achieve better symmetry between the right and left areolar dimensions. There’s nothing wrong with proceeding with the breast augmentation, allowing the implants to settle, and then re-evaluating. That way, you have a breast lift only if you feel it is absolutely necessary. (Kenneth Dembny, II, MD, Milwaukee Plastic Surgeon)
It doesn’t appear that you will require a breast lift. You may want to consider high profile or anatomic implants to help lift the breast with an augmentation alone. Consult with a Board Certified Plastic Surgeon.
There is some asymmetry and a small areola lift may be necessary to match them a bit better, but an exam in person would be essential to determine the appropriate procedure. (Steven Wallach, MD, Manhattan Plastic Surgeon)
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However if you were considering round implants you may need a slight adjustment in the nipple areolar position. If you were not keen on any scars on the breast you could consider high projection anatomical implants.
I recommend you find a specialist plastic surgeon in your area who can examine you and help you make a decision. (Vijith Vijayasekaran, MBBS, FRACS, Perth Plastic Surgeon)
This condition is due to the formation or persistence of a fibrotic bands or flanges which connect the cutaneous dermis with the superficial fascia at the lower pole of the breast causing its underdevelopment, this in turn produces a hypertrophy or enlargement of nipple areola complex and breast ptosis.
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Although your breasts do not have the classic form of this condition the treatment can be similar , ie , in your particular case it should be performed a releasing of such bands or flanges by means of radial cuts at the lower pole to permit its expansion , the placement of the implants either in pre – pectoral space or retropectoral according to surgeon preference ( we prefer the retromuscular space) and finally should be made a reduction of the areola diameter or a periareolar pexia . (Jose Luis Acosta Collado, MD, Dominican Republic Plastic Surgeon)
It appears that you do have some ptosis (drooping) of your nipple/areola and although this will improve with implant placement you may still have some degree of ptosis after surgery. Furthermore the areola appears wide and this will possibly be just as wide or even wider after implant placement. A breast lift can help fix these issues but it is your choice.
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You can always have augmentation first and then have a lift later if you are not happy with the result. (Mark Deutsch, MD, Atlanta Plastic Surgeon)
Lift and implants or just implants?
I can give you the best advise: go and see a plastic surgeon in person, your breast lift with augmentation before and after photos show that your breast are sagging a little so you could have just implants (high profile) or a periareolar lift with implants but to know what is best you need to see a plastic surgeon (Australia Fragoso Baez, MD, Dominican Republic Plastic Surgeon)
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