Q: Breast Augmentation with or Without Mastopexy? (photo)
I’ve had consultations with 2 surgeons so far. One said I’d achieve a good result w/ just implants. The 2nd one measured me & said that to achieve my desired result, I need a circum-areolar lift w/ implants to fix my nipple position & reduce the size of my areola. I’m looking to restore upper pole fullness & desire the round, perky look. I want the best result possible, but I also wasn’t anticipating the extra scars. Could this be achieved with implants alone or is a lift really necessary?
A: A lift can improve but may not be necessary results with an augmentation
Looking at your photos, you are really on the borderline of whether a lift would be better or not. I have a patient posted on my web with the same level of ptosis (sag & nipple position) so you can see what it will look like with just an implant. In general, to get an aesthetic result, the nipple areolar complex should be between 18-22cm from the notch in the chest bone; there should be normal skin visible below the areola; and the size of the areola should match your desired size, (the ideal size is 3.8-4.2 cm). You have show of skin below the areola, but a little less than ideal. You can not count on the implant to lift the areola, with time the pocket will fill and the implant will settle and the areola will be minimally elevated. Your areola are not too large, but if you would like a smaller areola, then you could consider having them reduced. I am not a fan of the periareolar lift in general because the eye follows the circle around the areola and becomes the focus of the onlooking eye, so if you like the size of the areola, I would prefer a crescent above the areola to be removed that does not go all the way around. The crescent excision can also be positioned obliquely to center the position of the areola on the breast if necessary, (your right areola is slightly more medial than the left) . If you do not mind the size of the areola and are happy with the position of the nipple areola on the breast then I do a transareolar incision which is the most hidden scar of all and becomes barely visible with time. My recommendation is to look at MANY photos of before and after with breast like yours and decide what look you like best. I do not believe a lift is necessary in your case, but a slight elevation of the areola will likely give a slightly more aesthetic result. Check you before and after photos. Good luck!