Q: Dr. Eppley, I am having trouble deciding whether I need a breast lift alone or should have implants with it. I am 35 years old, had 2 kids and am a fairly full 34C. I do struggle to keep them in a C bra however. While I am happy with the size of my breasts I am not so with their shape. I just want back my fbreasts back up where they used to be and were nice and perky. I know I need a lift but am uncertain about whether an implant is necessary? I have several plastic surgery consutations and have been given different opinions, one says I definitely need it the other I cn have it or not. Neither doctor seems to be able to explain why in terms that I can understand and, quite frankly, they both seemed a little uncertain themselves.
A: The breast issue that you have is a common one, once full breasts have fallen even though they have not necessarily gotten smaller. This has happened because of two breast tissue changes, there is now more skin and less internal breast tissue. That combination makes the change from a perky to a saggy breast. While you are happy with your breast size now know that they appear the same size because of the extra skin. When they are lifted, the breasts may appear smaller because a lot of extra skin has been removed. While breast lifts do not remove volume, this is why some women will have the perception that their breasts are a little smaller after a lift. There is also the longer term issue in that most breast lifts will lose the initial upper breast fullness that exists right after surgery as they settle with tissue relaxation. The role that a small breast implant may play for you then is in maintaining upper pole fullness and avoiding the fear that you may look a little smaller after a lift alone.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in breast augmentation. Iwant fuller breasts to eliminate the stretch marks and I would like to go one size bigger. I am a size B now. I have attached pictures so you can see what you have to work with.
A: Thank you for your inquiry and sending your pictures. I can see your concern about breast size and there is no question that implants would be beneficial to get you from a B cup to a C cup. However, no amount of increase in breast size will eliminate your stretch marks. With the expansion of skin from breast implants, stretch marks may become somewhat less noticeable as they are pushed out and stretched flatter. But the concept of stretch mark elimination should be erased from your mind as an expected outcome. The one concern that I have about your breasts is what degree of sagging they may have. The pictures are taken with your arms up which artifically lifts them and may camouflage the actual amount of sagging. Breast implants do not lift sagging breasts which is a common misconception. So whether you may or may not need some form of a breast lift with your implants remains uncertain. When you have the amount of stretch marks that your breasts do, this adds to that concern. If you can send me some new pictures with your arms at your sides, that would help answer that question.
Dr. Barry Eppley
Q: Hi Dr. Eppley I just had a combined breast lift with implants less than three days ago. I have several concerns at this point and want your opinion. My left breast seems to currently have a different shape than my right (more fullness to the top and more stiff on the top). I don’t know if it’s usual for them to have different shapes at the beginning of recovery if they were different sizes to begin with (my right was bigger than my left before surgery).
A: It is very common with any type of cosmetic breast surgery at this early postoperative period (48 hours) to have breasts that have some differences. This is a function of many factors including peak swelling that occurs 48 to 72 hours after surgery, the fact that no two breasts swell the same afterwards even if they had the identical operation, the fact that they are heavily taped which distorts them, and your pre-existing asymmetry (which will be improved but not cured).
For all of these reasons, I would not even try to look at them and come away with any assessment. It simply is way too early and substantial changes will take place over the next 4 to 6 weeks in both breasts as swelling subsides and the breast implants and tissues settles.The time to get more critical is 6 to 8 weeks after surgery but certainly not now.
In the end, I believe there will be some mild asymmetry in shape and the nipple position as this always occurs after major breast recontouring. (combined breast augmentation and breast lifts) But there is no way to get idea about that at this point. I know it is hard but my best advice is to stop looking at them for now.
Dr. Barry Eppley