So, you decided to get your breasts enhanced? Now, you need to figure out exactly what needs to be done. One of the biggest questions I get in my southern New Jersey plastic surgery office is “Do I need a lift or just implants?” While I have discussed this issue before and there is a page on my website devoted to this issue, it certainly deserves discussing again.
There are three operations that plastic surgeons perform on the breast. The most straightforward is placement of a breast implant. If your breasts are perky and small, this is the perfect option. An implant is placed and makes the breasts bigger. We need to decide on saline or silicone implants, but this will be the topic of another day. The other extreme is the lady with very saggy breasts. Often simply due to the way they developed or with weight loss or pregnancy/breast feeding, the nipples hang down and the entire shape of the breast is pointing downward. In this case, surgical option #2 is a breast lift. A breast lift is an operation where excess skin is removed, the tissue is repositioned and tightened, and an rejuvenated slightly smaller breast is the result. Option #3 is a combination of a breast lift and an implant. This is the case where the breast needs to be lifted, but an implant is also needed for volume. It is only safe to combine lifts and implants in some circumstances, which will be a topic for another day.
How do you know which you need? Well, if you love the shape of the breast and nipples point forward and your only complaint is size, then an implant alone will likely solve the problem! Unfortunately, if the breast is starting to sag, an implant alone will not lift the breast to any significant degree. In this case, the implant will give you a bigger saggy breast. That is certainly not an ideal goal, but one that some ladies choose to accept to avoid the scars of a breast lift.
Unfortunately to lift the breast, incisions are needed to remove the excess tissue. Anytime there is an incision there is a permanent scar, and thus it is understandable that in an ideal world we would avoid lifts. This is not reality, and some breasts simply require this procedure. The amount of scarring will depend on how much excess tissue there is and what type of lift will be performed. I will discuss various lifts in the next post.
A simple test to see if you need a lift has been known as the “pencil test.” If your breasts have come down enough that you can place a pencil behind the hanging skin (in between the breast and your abdominal wall/ribcage) and it stays there by itself, you probably need a lift. If the nipple is positioned near or at the level of the breast base crease you likely require a lift.
I see ladies who have gone to other surgeons and received large implants in order to attempt to avoid a lift. They are always upset and always blame their surgeon. This plan does not work. I would highly caution any lady with sagging breasts not to simply get large implants. I hear this from ladies often that “well he said I could probably get away without a lift.” I had a lady come see me recently that I had seen 4 years ago. When I saw her initially I suggested a lift. She went to someone else in the same zip code 08003 as me who told her she would be fine without a lift. He ended up placing 600cc implants in an attempt to mask her droopiness. Now she complain that she has huge droopy breasts. I operated on her a few weeks ago performing a lift and downsizing her implants. She is delighted now that the proper procedure was performed. I worry about that comment because in my opinion a breast cosmetic surgeon should be able to look at a pair of breasts and in 2 seconds tell you what operation is best. I believe that surgeons do this because the lady doesn’t want a lift full well knowing that she will be back to get one. Beware of this.
I hope this explanation helps!