I get this question a lot.
For the Palo Alto women with too much to do today and need the down and dirty synopsis: Avoid the implant if you can. If you need it for volume, then you need it. If you are doing an implant just for shape, particularly if you are a full C cup or more, there are things you need to think about.
Why?
First let me say the old school teaching was you always needed an implant. “You won’t get good shape without an implant.” ” You need it for fullness.” yadda yadda. This was likely true for some of the lifts, particularly the periareolar lift (donut) which tends to flatten the breast, and the inferior pedicle (anchor scar pattern) lift. I don’t think this is as true for the lollipop vertical lift. It is true there is not as much fullness in the tip of the upper part of the breast without an implant. (Mostly seen when you are naked. With a bra on, this fills out.)
Breast lifts are great to reshape and lift the breast. If you have a sizable amount of natural tissue (read C cup and above), gravity will cause your breasts to age over time. Even if I lift it and make it super shapely– and you wear bras 24 hours a day, you are done with kids and breastfeeding, and you promise never to jog–you can’t stop gravity. (Sorry! I have applied for a magic wand. Still not here in mail.)
So due to this gravity stufff , if you use an implant, things which will happen:
- The weight of the implant adds to the weight of your breast. Heavier breast= more aging with time/gravity= more droop.
- Your natural breast tissue will age faster and more than the implant. This means in 10 years or 20 years your implant will still be up there, but your natural tissue will hang low, kind of hanging off the implant.
- You have all the risks of the implant: infection, malposition, migration, capsular contracture and hardening, and implant deflation.
- You guarantee yourself a second surgery at some point to fix it all. That surgery may be in 10-20 years. How is your current health? How old are you? How will you be then?
If you are an A/B cup and want to be a C/D, then you need an implant for volume. That is a different story. My patients who are naturally a C or more tend to want the implant for shape. Maybe they do want to be a little larger, but when deciding to go larger you need to consider the negatives I discussed above.
I do breast lifts with implants, but I discuss this in detail. Think about your ideal now, in 10 years, and in 20 years. What are you willing to do for it? Is another surgery down the line okay? If you don’t go larger will you be unhappy? If more volume is a must, then do it. If more volume is a I-would-kinda-like-it, maybe-it-would-be-fun, I don’t advise the implant.