Understanding “Perky” & The Limitations of Breast Implants

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There is a lot of confusion among our Phoenix breast augmentation patients around whether they will need a breast lift in order to achieve an ideal breast shape. To be honest, I find that a lot of plastic surgeons are confused about this concept as well.

The main concept that needs to be understood is the issue of volume versus shape / perkiness. The addition of volume via implants or fat grafting mostly affects breast size and doesn’t lift the breast in any significant way. In fact, adding more weight to breasts can accelerate the drooping process. Some patients already have nice breast shapes, but are simply too small. These patients are ideal candidates for breast augmentation in order to increase size. Other patients have deflated appearing breasts with minimal to no skin overhang. These patients also can benefit from augmentation only, as the volume will fill up the empty “skin envelope”.

Where patients get into trouble is when the breasts are not merely “deflated,” but they also have significant skin excess and overhang. In these cases, they still need the addition of more volume to restore size, but they also need skin tightening to improve the shape and youthful appearance of the breasts. Without a lift, these patients will simply have larger, droopy breasts after surgery. Furthermore, the strategy some surgeons suggest — adding a large implant to avoid performing a lift — is counterproductive. Not only do the breasts not look perky with this approach, but over time, the large implants stretch the skin out more, causing tissue damage and a more aged appearance.  The damage from large implants placed in patients with weak tissues is one of the more common root issues that I see when evaluating patients for revision breast augmentation.

Finally, there are patients who already have enough or too much breast tissue in combination with breast drooping. In these patients, a breast lift is the critical procedure needed to correct the problem. Not only do I avoid an implant in these cases, but I  sometimes recommend tissue removal to improve the proportion of the breasts. If these patients want a smaller breast overall but want to selectively add upper breast fullness, I frequently will offer fat grafting as a way to focally improve upper breast pole volume without adding much weight to the lower breast. This creates a better shape while keeping the rate of re-drooping as low as possible.

The bottom line: If it looks like you need a lift, you probably do, and attempts to avoid what is necessary for reshaping by overcompensating with size will generally backfire. Nobody wants more scars than they need, but shape, symmetry, safety and longevity should be the primary goals with breast surgery. Don’t cut corners when trying to achieve an excellent result when a lift is warranted; the scars are usually a fair trade off for the dramatic improvements in shape and perkiness.

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