Thanks so much for taking the time to reach out.
The lift vs. no lift question is actually more complicated than it seems. This is one of those things that requires about 10 minutes of back and forth conversation in a consult to really know the right answer so I apologize if this is too all over the place.
I look at it like this:
There are three things (oversimplified, obviously) that we frequently do to change the aesthetics of a breast.
1. Reduction to make the breast smaller. This always includes a lift.
2. Lift without making the breast significantly smaller.
3. Implants to either change the shape or the size of the breast.
The first two are somewhat interchangeable. A reduction vs. a lift can be a pretty grey area. But implants vs. a lift don't have a ton of crossover if we want long term results. Meaning that things can be done, like dual plane and larger implants, or above the muscle and larger implants, but if a person needs a lift for the shape she desires, implants just don't usually do enough long term. Gravity almost always wins.
Also, there is more than one reason to consider a lift. For some people it is about lifting the breast tissue and the areola. For others, it is about changing the shape of the breast. And for others it is about lifting the breast tissue to match the position of an implant. For example, an implant will often lift up the upper border of the breast a few centimeters. If the breast tissue naturally sits low, making the upper part of the breast higher can make that more noticeable.
There are some times when I look and think: That person needs a lift. And there are other times when I look and immediately know: That person does not need a lift.
You fit into the third category: You might need a lift, and you might not, depending upon your ultimate goals and your exam.
I know it would be more useful to you for me to say: you fit into the first or second, but I really think it would be the third and it would depend a lot on things like VECTRA or 3-D imaging and a good, long conversation about goals and possibilities.
Let me know if I can be of any further help.
Another great question. The donut or crescent seem like really good choices because the scarring quantity is less but they do two things that aren't great.
1. They tend to flatten the center of the breast (because it's just a circle that is getting cinched tighter). Sometimes this is useful, like when the areola or center of the breast is puffy. Oftentimes, it isn't helpful. Other times it is neither harmful nor helpful.
2. Tightening a circle while putting something underneath it that is pressing outwards (the implant) can put a lot of pressure on the circle to widen. So widening of the areola can be an issue.
Some surgeons use the periareolar techniques a lot. I use them pretty sparingly. That is partly because the vertical scar tends to heal really well and partly because the vertical scar allows me to change the shape, the height and the width of the breast instead of just the nipple position.
The short answer is still. . . it would depend on an exam. The long answer is. . .honestly, the same.
You might lose a very small amount of volume with a lift but there are ways to do the surgery that don't require anything other than the loose skin to be removed. Those techniques can take the breast tissue in the bottom of the breast and reposition it in the middle of the breast to create a fuller shape BUT not by much. If fullness is your goal, something other than just a lift would be necessary. Sometimes we use fat from somewhere else to create that fullness (not very often, though) but most of the time that means an implant.
This is where VECTRA is so useful. We can mimic a lift without an implant and show you what that might look like, show you a lift with an implant of different sizes and then show you implants without a lift. It's not a perfect representation but most people look at the options and almost immediately know what they want.