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…)
I recently read a blog post by a plastic surgeon in Manhattan who specializes in rhinoplasty. The surgeon made a point that I have seen echoed by quite a few other plastic surgeons on RealSelf.com when answering questions from patients going through rhinoplasty recovery.
The question being posted across multiple online forums is: How different will the nose look 1 year after surgery as compared to 3 months, or 6 months? In other words, “If my nose looks great at 3 months, will it still look good a year from now? Or will it look overly defined and tight as more time passes?”
My opinion is this – there is no definitive answer. Each nose is different and no one can predict how your nose will change over time. However, one thing is glaringly clear to me about rhinoplasty recovery: If the nose doesn’t look good at 3 months, it isn’t going to look good in a year.
Perhaps the two most frequently asked questions I receive from women interested in breast enhancement surgery are:
- “Do I need a breast lift with or without implants?”
- “Can I get an ideal result with just breast implants?”
As with most operations, it’s always best to get things right the first time around. And when it comes to breasts, getting it right doesn’t typically mean looking great for only a few short years before the effects of gravity and time undue all the good work that was done.
So when I advise my mastopexy (breast lift) patients on what their options are for achieving the best and most youthful looking breast possible, I always make sure that they have a crystal clear understanding of what their surgery options are and how each option will look and feel over time (re: 1 year, 5 years, 10 years etc.) rather than just what they can expect to look like during the immediate post-operative period.
9 times out of 10, the best path forward is clear and the patient is in full agreement that the procedure’s pros outweigh any cons that may inherently be involved (e.g. a slightly longer incision in return for a stronger, more longer lasting lift).
Of course, not every breast fits perfectly into one of the the breast types described below, but most do, so hopefully readers will find the following example photos and procedure recommendations helpful and/or informative , especially if they are considering their options for a breast lift with or without implants/augmentation.
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 – 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).