The decision to do a breast augmentation without lift versus a breast augmentation with a breast lift, however, is less based on patient preference and more dictated the saginess, the nipple position, and the ratio between the breast volume and the amount of excess skin that is present.
How Ptotic Are My Breasts?
The gold-standard method of assessing the need for a breast lift is the “pencil test.” Standing in front of a mirror, lift the breast and lay a pencil in the fold under the breast and allow the breast to settle over the pencil. Look at the position of the nipple in relation to the pencil.
The lower the nipples and breast are below the pencil and the more excess skin you have, the greater the chance you will need a breast lift and the more of a breast lift you will need. If your nipple and a majority of your breast are at or above the pencil (Normal), you will likely get a great result from a breast augmentation alone. Larger implants can shift this equation slightly for patients that have borderline ptosis (Grade 1).(more…)
Question – What is the best way to correct breast ptosis, high or moderate profile implants, a breast lift or both?
I am 36 years old, breastfed 2 kids, and have lost volume in my breasts. I have some sagging but my nipple is still over the fold. I weigh 130 pounds and am very fit and toned.
I am 5″4″ and my breast size is a 34B. Before my kids I was a 34C cup. When I was breastfeeding I was a 34D cup. I would like to be a D cup and wonder what type of procedure would be best to correct my ptosis?
Answer – Since you have a small amount of glandular ptosis (pseudoptosis), you not only want to fill-OUT, but lift-UP a little as well. Therefore, my approach would be a dual plane breast augmentation, which would fill out the inferior/lower pole nicely, give you muscle coverage across the upper two thirds of the breast and a nice, slightly lifted appearance.
More specifically, given your body measurements and photo (which shows pseudoptosis with mild Grade 1 ptosis), I suspect that 450cc moderate plus profile implants are needed to give you both the breast size (D cup) and breast lift you desire.
How To Classify/Grade Breast Ptosis
Simply put, grade 1, 2 or 3 glandular ptosis, which refers to how far the areola is sagging below the inframammary fold beneath the breast, the lower attachment point of the breast to the chest wall.
- Grade 1: Mild Ptosis – The nipple is at the level of the inframammary fold, but most of the breast tissue is below the nipple.
- Grade 2: Moderate Ptosis – The nipple is located below the inframammary fold and below the majority of the bottom breast tissue.
- Grade 3: Advanced Ptosis – The nipple is far below the inframammary fold and points towards the floor.
- Pseudoptosis – The nipple lies above or at the level of the inframammary fold while the majority of the breast has descended below the level of the fold. This is not true ptosis, or sagging.
Question – Will High Profile breast implants give me natural looking breasts vs Moderate or Moderate Plus?
I am 5’4″ 125lbs, 31″ ribcage, 34C (wanting at least a DD) and my breast measures 13cm wide. I told my PS I wanted large, very nice looking (not high and ball-looking) breasts. He told me he will use a smooth, round, High Profile, 500cc silicone implant and it will look “very nice” with a “nice downward slope”. Everywhere on the internet says that high profiles don’t give a really nice natural look, and that moderate profiles do. Will high profile breast implants give me large, full, and natural-looking breasts with nice cleavage?
Answer – Although I use Moderate Plus or Moderate Profile prosthesis in the vast majority of cases, given your base width dimension of 13.0cm and your wanting a 500cc implant, a High Profile implant would be appropriate.
In answer to your question, it is not so much the size of the prosthesis that results in a ‘natural’ or ‘unnatural’ look but rather the surgical technique used in relationship to the pre-operative breast appearance.
If, on examination, your nipple to inframammary fold distance is 5.0cm – 6.0cm (meaning that the fold does not need to be lowered excessively), then a high profile implant can be placed in a position that provides adequate inferior/lower pole projection and avoids creating an overly round upper half of the breast (i.e. the “high, ball-looking” and ‘unnatural’ look you don’t like).
That said, there are many women who like the look of round, projecting breasts with upper pole fullness (high cleavage) – neither look is ‘right’ or ‘wrong’ so to speak, they’re just different. Every plastic surgeon has a certain aesthetic style they prefer (re: some aim for the most natural looking shape and size possible while other find the ‘high and round’ look more attractive), but at the end of the day, if the patient is clear about the way they want their breast to look after surgery, it’s my job as their surgeon to achieve it (within reason of course).
Before diving into a few specific recommendations given the measurements you provided, here are my general thoughts on each of the 3 Mentor breast implant profile types:
Question – Undecided, Lift or Implants. Surgery in 3 Weeks, Opinions Please
Hello. I have my breast surgery scheduled in June, however, am still undecided which route I should take. Would 500cc saline implants be sufficent to give me some volume, or will I end up with large, saggy breasts? If I decided to go just for a lift, my boobs will be tiny and scared. Hence, I’d rather go for implants even if I will have to get a lift 10 years down the road. I don’t want both surgeries, so it will be either tiny or big. What to do? I’m 40, 1 child. Thank you.
– via RealSelf.com
Answer – For the best result possible, a vertical breast lift + submuscular, moderately sized implant is needed
In response to your question and based on your photos, this is not really a one or the other type of situation. You really need to have both a lift and an augmentation. If you do them separately you will probably not be satisfied with the eventual outcome. You have significant loss of volume, and if you were to only proceed with skin tightening all that would be accomplished is a higher position of the nipple areola complex. There would be no superior fill and an even smaller appearing breast mound.
Question – I think my “goal” photo = a perfect breast augmentation. Is it possible for my breasts to look similar after implants? Am I being realistic about what’s possible for me?
My plastic surgeon wants me to bring in pictures of what I want to look like after breast augmentation so he can be sure that he understands what “look” I like best. We’ve discussed this at my consultation; however I did not bring any pictures with me. My surgery is on the 5/26/2011. At my pre-op appointment, we will go into the specifics of the look/result I am hoping for. The first two pictures are “before photos” of my breasts and the third is what I believe is a perfect breast augmentation. The measurement from my collar bone to my nipple is 21 cm on both breasts. Am I being realistic? Thank you!
Answer – For a similar result to the “perfect breast augmentation” look you like, a lift is needed.
I agree with my colleagues that it is difficult to compare apples to oranges since every breast has its own unique characteristics, but since the photo you chose as an example of your ideal postoperative outcome is mine, I will give you my thoughts on the situation. (n.b. here’s a link to the ‘perfect breast augmentation’ case you cited as an ideal result).