Breast Augmentation: Cost, Reviews, Photos

Breast implants – lift – Both?

You yourself may not be able to conclude what is best for you. Seek out an experienced board certified plastic surgeon who should do several things in the consultation. First, he/she should listen to your concerns, your goals and your expectations. Secondly, he should take a thorough medical and family history (especially of breasts).

He should then do an examination, to include breast measurements (location of the nipples, location of inframammary folds, asymmetries) , breast exam for lumps, measurement of skin elasticity, etc. Only after a thorough evaluation can the surgeon then advise you as to what procedure would be best to achieve your particular goals and expectations.

He/she should discuss the pros and cons of either separately or both together, along with the potential risks and complications, expected results and scars to expect.

The use of silicone vs saline implants, placement of incisions and location of the implants relative to the underlying muscle (pectoralis major) should be discussed.

Certainly future breast examinations (including mammography) and natural aging processes should be discussed. Especially with ptosis (or drooping) of the breasts you need to know what the potential is for drooping in the future and what can be done at that point. Finally, unfortunately, as many as 1 in 6 women in the USA will develop breast cancer in their lifetime and you need to know what your options would be at that time and whether your surgeries will inhibit diagnosis or treatment (usually they don’t but you need to know everything to make an intelligent decision). Breast lift or breast augmentation? (Theodore Katz, MD, FACS, Philadelphia Plastic Surgeon)

Breast Donut lift or breast augmentation?

The answer to this question depends on whether or not you want added volume to your breasts or just a “lift” of the nipple/areola. If you do want to be larger, you may want to cosider a breast implant. If not, a lift only can be very effective at lifting the nipple/areola in an aesthetically pleasing way. If you want both a lift and added volume, consider a lift and an implant. Both can be done safely and at the same time for a fantastic result. How to choose between breast lift (mastopexy) or enlargment (augmentation with implants) or both (Jeffrey E. Schreiber, MD, FACS, Baltimore Plastic Surgeon)

How to choose between breast lift (mastopexy) or enlargment (augmentation with implants) or both

I am enclosing the information you are requesting about a breast lift (mastopexy) or enlargement (augmentation mammoplasty) . It is important to understand that a breast lift will lift the nipple to give it a more firm appearance.

However, it does not make your breast feel more firm (usually achieved with an implant). BREAST LIFT (MASTOPEXY)An office visit/consultation is mandatory prior to scheduling the procedure. The following information is based on a breast lift procedure only. During the consultation. Two of the most important issues are: the amount of sagging (called ptosis) and the amount of natural breast tissue. These two anatomical features must be taken into account in order to advise the amount of lift and whether implants could be placed above/under the muscle.

It is very difficult to describe over Email and more easily performed during a consultation. The correct procedure for you depends on several factors. PTOSIS:Although this can easily be performed with any breast, there are certain features which make some patients better candidates for various techniques. Probably the single most important factor in determining if you are a good candidate is the degree of ptosis (sagging).

This is classified according to the nipple position in relation to the crease beneath the breast (where the underwire sits). Some people use the pencil test; standing in the upright position, place a pencil horizontally beneath the breast crease and let the breast fall on to the pencil thereby holding it against you chest, if the nipple rests at or above this horizontal line, then you are a good candidate for the augmentation procedure alone. If it rests at slightly below the breast crease, then you a may be a candidate for minimal incision lift procedures (crescent or donut lift) with or without an implant.

If it rests more significantly below this horizontal line, a more extensive type of lift (vertical or donut or vertical/horizontal incision) is likely required with/without an implant in order to achieve a more optimal result. TISSUE: The amount of breast tissue you have may help determine whether an implant can be positioned above or under the muscle. If you perform a skin pinch on the breast tissue and this is less than an inch in thickness, you may be better off putting the implant below the muscle in order to avoid the “bubble look”. If put above the the muscle in a thin, small breasted individual the implant will be obvious.

Think of a baseball under a silk sheet. If your breast pinch is more than an inch thick then you can choose to put it either under or over the muscle. Think of a baseball under a thick comforter. In either situation, changes can occure with advanced aging which will effect the long term appearance of the breast and may require additional surgery in the distant future.

These looks have been termed the “double bubble” look for under the muscle or “rock in the sock” for over the muscle. The choice of incisions vary tremendously and depend on the extent of the drooping (called ptosis). Incisions may be limited to or around the areola (the pigmented part of the nipple/areola complex), may extend straight down from the nipple, and/or may require and incision under the breast as well. If implants are required, I generally prefer smooth implants placed under the muscle using an incision under the breast. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

Generally, when the nipple areolar position is too high after a mastopexy augmentation, the cause is inferior displacement or “bottoming-out” of the inferior breast fold.

This can happen with any breast operation, and can be fixed, but can recur. The most common complaint is that patients feel that their nipple areola areas pop out or can be seen from the top of a bra or bathing suit.

Rarely is the cause from inaccurate measurements for the new nipple position prior to the breast lift. Treatment consists of elevating the inframammary fold to a higher, more natural position. Either permanent or semi permanent sutures are used, and most plastic surgeons requiresome type of rigid bra support such as an underwire bra to help the area heal in the correct position.

I like my patients to wear this support 24 hours a day for approximately 2 months after surgery. (Daniel Shapiro, MD, Scottsdale Plastic Surgeon)

The ideal nipple position after breast augmentation is centrally located over the breast mound. When the nipple is positioned too high it may be difficult to wear certain clothing without the areola showing.

Depending on the reason for the high position, revisional surgery can usually correct this issue. For example, if the implant has ‘bottomed out,’ it can be repositioned which may fully correct the nipple position.

Other options are available and can be tailored to your particular situation. I wish you well and have no doubt that your surgeon will guide you appropriately. (Louis DeLuca, MD, Palm Beach Plastic Surgeon)

The position of the nipple and areola should be centered over the breast, and with time their relative position may change. It is usually easier to reposition the nipple and areolae superiorly, but they may also be lowered if necessary, although this leaves an additional scar on the skin above top of the areola. (Olivia Hutchinson, MD, New York Plastic Surgeon)

There may be one of two possible problems: One possibility is that your implants have descended or moved downward on your chest relative to the breast. If this is the case, treatment consists of elevating your inframammary fold (i.e. the crease underneath the breast) with sutures or possibly additional skin resection with a revision mastopexy. The other possibility is that your nipple-areola complex is truly too high on your breast.

The second scenario would also require revision breast surgery, possibly with breast tissue expanders. (Jaime Perez, MD, Tampa Plastic Surgeon)

Nipple position too high after augmentation mastopexy – a problem that may be easy, or not, to fix. If your implants are bottomed out, then correcting their position may fix the issue.

If the nipples are truly too high, then additional corrective surgery may be needed – that could include tissue expansion, then smaller implants. (Carmen Kavali, MD, Atlanta Plastic Surgeon)

Correcting of nipple position after breast augmentation can be a difficult procedure. But it can be done and sometimes not with significant scarring. The reason for high nipples will help determine what needs to be done. This reason can be nipple related or implant related.

1) The nipple position after breast augmentation may have been placed in a high position at the initial surgery. If this is the case, some of the skin below the nipple may need to be removed with new scars placed. Also, depending on how far the nipple has to move, scars may be needed above the nipple.

2) Sometimes, the implant can be placed too low or drop over time. This situation can be fixed by repositioning the implant. Unfortunately, the procedure is not as simple as putting the implant in a new position as it has to stay there.

It can be done, but it is technically difficult and sometimes there will be recurrence of the original problem. (Naveen Setty, MD, Dallas Plastic Surgeon)

Nipple position is important in breast surgery especially when you combine a donut lift with an augmentation. This is very difficult to combine and many surgeons will not perform both procedures at the same time. Nipples being too low is more common and easier to fix; nipples being too high is difficult to correct. This may be due to implants “bottoming out” or sliding beneath the fold of the breast, or improper nipple positioning at the time of the operation. Attempting to reduce the size of the areola may help “lower” the position by as much as 1 or 1.5 cm (reverse donut lift) but you really need to be careful because it can also make things worse in the long run. (Richard H. Fryer, MD, Salt Lake City Plastic Surgeon)

Augmentation alone or augmentation with a lift are both an option. If you wish to have your nipples sit higher, you do need a lift. A lift will also allow to make your areolas smaller (Martin Jugenburg, MD, Phoenix Plastic Surgeon)

Breast lift needed or not

All depends on your goals. You look like you could have a breast augmentation only and have larger and less deflated looking breasts.

If you have a lift at the same time then you can make the aerola smaller and maximize the perkiness, and position on your chest wall. But there is more scar with that choice. Have a consultation and discuss all the options. (Scott W. Vann, MD, FACS, Savannah Plastic Surgeon)

Great posted photos but IN PERSON examination always better. My over the internet guess is implant with donut lifting . (Darryl J. Blinski, MD, Miami Plastic Surgeon)

An implant would give the benefit of more fullness in the upper pole of your breast and a slightly fuller size. You appear to already be in the range of a large B, so I’m not sure if this is what you would be looking for. Also, if you wanted the areola size decreased, then you would most likely need the scar that would result from (or at least part of the scar) a lift. I think you would be a good candidate for an implant, possibly with a small lift, but you need an in-person exam with a plastic surgeon in your area to evaluate this. (Erik Hoy, MD, Newark Plastic Surgeon)

From the looks of your photos and given your goals, a lift with an implant is the best approach. (Justin Yovino, MD, FACS, Red Bank Plastic Surgeon)

Implant vs implant and lift

Based on your photos you submitted, it’s hard for me to tell where exactly your breast fold is in regard to your nipple/areola complex. The correlation of this reveals if a lift if warranted.

In some cases, when an implant is placed at time of surgery, the patient is sat up on the table and the need for a lift is determined at that time based on the look of the implant as well as the outcome the patient is looking for. My advice to you would be to go discuss your options with a board certified plastic surgeon. (Michael Ian Rose, MD, Columbus Plastic Surgeon)

Breast Augmentation or Mastopexy

I would recommend that you schedule a consultation with a board certified plastic surgeon in your geographical area. Upon consultation and examination your surgeon will be able to make a treatment recommendation to address your concerns. (Christine Sullivan, MD, Atlanta Plastic Surgeon)

Breast implants are fillers. They do not change the shape, but make them larger. Consult with a Board Certified Plastic Surgeon for an exam to determine if you will be happier with larger breast, or larger breast with a perky look. Based on your photos, you appear to be a candidate for either. (Robert E. Zaworski, MD, Bakersfield Plastic Surgeon)

You would do very well with an augment alone, but they will not be “high and perky”, and possibly larger than you are hoping for. Nipple position typically does not change noticeably after augmentation (it looks different).

Usually when people say that they are looking for more of a lifted look to take up some of the extra skin without overcompensating with a larger than desired implant. In your photos your nipples arent necessarily low, so you would do well to talk to a couple plastic surgeons in your area and convey your goals, while making sure to clearly point out/explain the kind of results you are looking for. (Zach Barnes, MD, Toronto Plastic Surgeon)

I think you could achieve great looking breasts with implants alone with a dual plane technique and properly selected implants. However, if your goal is truly to raise your nipple up more than 1 centimeter, then you should consider a lift with your augmentation. If you have the resources and time, it is always safe and more predictable to get undergo augmentation and then undergo lift later. (Jason Mussman, MD, )

The pictures show that your breasts are set rather low on your chest wall – this is a normal variant, and not really subject to change.A lift is done to correct sagging by elevating the areolas and correcting excess skin (either by removing it or filling out the breast with implants).

From the photos, it appears to me that the areolas are pretty close to normal position. The bottom of the areola should be even with or higher than the breast fold. Adding to my difficulty is not fully understanding your goal. Many patients of about your size will tell me their size is a small C.

You will be better served by consulting with a plastic surgeon in your area who can review your goals, and how to get there. My inclination based on just what I have here is to suggests implants (assuming you want to be larger) and an areolar reduction or peri-areolar lift if you are having an areolar incision anyway. (Jourdan Gottlieb, MD, Seattle Plastic Surgeon)

This is a difficult call from photos alone. An implant may raise your nipple position several centimeters, but ideally you want placement to be in the center of the breast mound.

You might find an improvement in shape with a periareolar lift (mini lift). Find a Board Certified Plastic Surgeon and make an appointment to be evaluated in person. Take along some pictures of women with a similar frame to you who have the look you’d like to achieve. Listen to what they have to say about how best to help you reach your goals. Good luck. (Mary Lee Peters, MD, Seattle Plastic Surgeon)

Breast Lift or Not?

Your photos show a significant amount of breast ptosis. Just placing in an implant without a lift will create more droopy and un-natural looking breasts.

You will have the “rock-in-a-sock” look. They will be larger but they would hang even more.

Your breasts already have a significant amount of volume and therefore, I would not recommend placing in an implant.

A full breast lift with the longer scars (anchor scar) would give you the most lift and also allow for a more natural reshaping of the breasts. Later, after the breasts have healed, if you feel you would want them larger, then I would place in implants.

This secondary step will also allow an opportunity for more fine tuning of the breast shape. (Steven Svehlak, MD)

Implants without a breast lift

The heaviness of your breasts and your low nipple position create a very unfavorable situation if you only have implants placed. I would recommend a breast lift (probably a inverted T shaped scar) with or without implants, depending on what you are looking for in terms of size.

There are ways to help incisions heal better and minimize scars, however any surgical procedure designed to dramatically change the shape of your breasts will have scars assoicated with it – it’s one of those trade-offs that you have to be comfortable with. If you are looking to improve the shape and size of your breasts in swimming suits and clothing, it’s a great option.

If you can’t live with scars or truly form keloids, you should consult with a plastic surgeon and discuss your expectations so you can better make that decision. (Michelle Spring, MD, Kalispell Plastic Surgeon)

From the third photo of the result desired it appears to me the person had a large implant + donut lift. In you I feel a donut most likely would not lift enough even with a VERY large implant, like 750 or more. But in the end it is your decision. (Darryl J. Blinski, MD, Miami Plastic Surgeon)

you should not have implants alone unless you want a larger and more droopy looking breast that will only result in disappointment and more surgery down the road. This is often not what patients want to hear when they have had generous breast volume and a nice breast shape at a young age only to see their breasts stretch and fall. You still have lots of breast volume but the shape can only be improved with a donut lift. Combining the lift with an implant will allow you to achieve a larger final breast size with the additional cost and risks of the combined procedure.

There are significant trade-offs associated with an isolated breast lift vs. an augmentation mastopexy (implant + breast lift) that need to be discussed with your PS. Each person is unique so each discussion and final plan will also be unique. I would also recommend a standard breast lift that involves an “inverted T” or “anchor” shaped scar as your only option for a breast lift.

I find that when my patients understand their options and their limitations, they can confidently make a decision about whether to have cosmetic breast surgery. Every patient deserves good advice even when they are hoping to avoid more extensive surgery. (Mathew C. Mosher, MD, Vancouver Plastic Surgeon)

From the pictures that you submitted, I see a significant amount of drooping of your breasts. I do recommend a breast lift if you are planning to have implants. There are ways that can help prevent or minimize the scarring. See a board certified plastic surgeon for your surgery. (James Tang, MD, Houston Plastic Surgeon)

Implant vs implant/lift

You have so much breast tissue and it hangs low enough that any option open to you has significant downside. If you put the implant under the muscle you will get a snoopy nose deformity. On top of the muscle, a rock in a sock deformity. If you get a lift as well be prepared for additional revisional surgery to keep your tissue centered over the implant to avoid a long breast deformity. Get more than one opinion and beware the surgeon who trivializes the risks! (Marcel Daniels, MD, Long Beach Plastic Surgeon)

Breast Lift with Breast Augmentation

If you were to have an implant without a breast lift your shape would be unsatisfactory. An above muscle implant would likely make you droopier and a submuscular implant would create a “snoopy dog” appeance which means that the nipple and breast gland would not be centered in the middle of the implant. You may not need an implant at all with a lift if you are happy with your breast volume, but have a good discussion with your plastic surgeon. (Mary Lee Peters, MD, Seattle Plastic Surgeon)

Your breasts have a significant amount of sagging. If you would like to have breast implants, a donut lift is also needed.

I have treated many African American patients without having keloid scars develop, although there is always a small risk of this occurring. (Larry Fan, MD, San Francisco Plastic Surgeon)

A breast lift is required

The breast implant has to be centered close to the nipple. Yours are low and the breast mound would be much to low. i would advise against breast implants only. (Miguel Delgado, MD, San Francisco Plastic Surgeon)

You definitely need a donut lift in addition to implants. I would, unfortunately, recommend the anchor lift. I’m sure others will recommend the vertical (lollipop) lift, but I think you are too droopy for that type of lift. Scarring is always an issue, however not all African Americans scar poorly. Good Luck! (Brian Klink, MD, Vacaville Plastic Surgeon)