Breast Implants Without A Breast Lift

This is a 38 year old mother who was dissatisfied with the appearance of her breasts.  As seen in her before photos, she presented with involutional and glandular ptosis (sagging and deflated appearance) and some laxity of the skin envelope.  During her consultation, I explained the benefits of adding a lift to correct this but after discussing in depth the pros and cons of adding a mastopexy to her surgical plan, she was not willing to have the additional surgical incisions to her breasts.  Prior to surgery, we also discussed the potential use of a subpectoral, dual plane, versus subglandular placement of the implant and I explained to the patient and her significant other that I would start with subpectoral and then a dual plane dissection during surgery and would defer to a subglandular implant placement if that gave the best implant placement to avoid a “double-bubble” or “snoopy-breast” deformity.  Due to the patient’s laxity of the soft tissue and glandual ptosis, a dual plane dissection was performed gradually to release the soft tissue to allow the implant to settle lower into the soft tissue.  During surgery, it appeared that the patient had an approximately 40cc volume discrepancy between her right and left breast with the left breast being larger.  Allergan Natrelle smooth round responsive silicone gel implants were used with a 485cc implant on the right and a 520cc implant on the left.