Implant Alone Would Make Things Worse
No one wants to perform or receive a breast lift unless it is necessary. The tradeoff is the increased risk of the surgery as well as additional scarring.
Unfortunately, in many instances you do not have a choice. I believe your situation is one of them.
A nipple needs to be centralized on the breast mound and if it is too low preoperatively, an implant can accentuate the deformity.
With early ptosis (sagging) such as first degree, an implant can correct the problem alone. When the ptosis gets beyond this level a lift needs to be done to centralize the nipple.
Do not misunderstand me, there are some surgeons today that will accept the continued sagging with the implant alone and in rare cases this may be acceptable, but for what I see in your photos the use of an implant alone would be aesthetically unacceptable. (Scott R. Brundage, MD, Grand Rapids Plastic Surgeon)
Saggy breast augmentation with or without lift?
I do not think that you would be happy over the long term with an saggy breast augmentation alone. Based on your frontal photo, your breasts do not pass what I call the “visible skin test”. You really need to see skin beneath the nipple areola on the frontal view, otherwise you are going to have persistent ptosis (or droop) following an augmentation alone.
I also do not personally recommend a strict subglandular augmentation to try to fill the volume loss without nipple areola elevation. In cases such as yours, I would do a dual plane augmentation and a periareolar mastopexy if you were adamant against the vertical scar with the lollipop mastopexy.
If you wish to avoid any contact between your inferior breast and chest wall, then you would require a vertical component. And last but not least, I am not a great fan of two separate procedures, since the vast majority of time when it looks like you will probably require a lift, then you ultimately will require a lift.
While the nationally averaged revision rate for a combined augmentation mastopexy is approximately 10% (my rate is much lower), the revision rate for breaking it into two separate procedures is 100%. (William F. DeLuca Jr, MD, Albany Plastic Surgeon)
A mommy makeover can include a full breast uplift or just a partial one with removing a crescent of skin above the areola. This does not reshape the breasts but it does reposition the nipple/areola at a higher level. Based on your photos, I would at least recommend that. We are offering special pricing on a mommy makeover as well as a resort stay probably for the price of just a breast enlargement and tummy tuck! We do get many patients from out of town taking advantage of our specials. (Edward J. Domanskis, MD, Newport Beach Plastic Surgeon)
Based only on your pictures and your description of “deflated” breasts, I would say that you would certainly benefit from a mastopexy/breast lift. Saggy breast augmentation alone will not lift your breasts up. I think many surgeons would place large implants in this situation in order to avoid a breast lift. In my experience this looks good temporarily but ultimately results in the skin being more stretched and looking worse over time. (Jeremy Waldman, MD, Manchester Plastic Surgeon)
Saggy breast augmentation does not lift low nipples
Your breasts show the typical changes of pregnancy and nursing; the upper part of the breast is deflated and the nipples are low in relationship to the crease under the breast. You might be able to get away with a subglandular implant (under the breast not uncer the muscle) but your breast will probably still look droopy, but larger. It is probable too that you will continue to droop more over relatively little time, particularly with the added weight of implants. You did not say what concerns you have about breast lift, but rest assured breast lift can be done with minimal scarring and will likely give you a nicer and longer lasting result. (Elizabeth Slass Lee, MD, Bay Area Plastic Surgeon)
You’re 41 years old and your breasts are moderately sagging, you probably not considering a sixth pregnancy. It is a good time to rejuvenate your breasts, saggy breast augmentation with periareolar lift will be the better approach and with minimal scars. (Erel Laufer, MD, Dunedin Plastic Surgeon)