I am wanting to have a breast lift with augmentation done at the same time---one surgery. My doctor is wanting to do these procedures, but in two surgeries. He said it had to do with the tension on the cut sites. I am a 36B wanting to go to a 36C. Will it make a difference--one surgery vs. two? Thanks, Sandy
Breast Lift Vs. Breast Lift & Augmentation. One Vs. Two Surgeries?
Doctor Answers (10)
One Stage or Two Stage Breast Augmentation/Mastopexy?
Thanks for the question.
This is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately and there are good plastic surgeons who can produce excellent outcomes in a single stage.
The combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time.
In my opinion, the decision to do the operation in a single or two staged fashion becomes a judgment call made by a surgeon after direct examination of the patient. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
I hope this helps.
Breast augmentation and lift
I usually perform a breast augmentationa dn a breast lift in the same operation. They certainly can be staged if the patient/surgeon are not comfortable.
Augmentation mastopexy - one stage or two??
For the most part, I do these in one stage especially if all the lifting needed is a periareolar one. If the breasts are droopier and need a full lift, I still do it in one stage generally unless the patient wants too big an implant to fit safely at the time of the lift or if there are any other reasons I am concerned about the conflict between lifting (TIGHTENING) the breast and augmenting (STRETCHING) it.
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Breast lift & Augmentation
To perk up a drooping breast, your surgeon will remove excess skin, reposition the nipple, and redrape and tighten the remaining skin to support the breast. The areola may also be reduced in size. A mastopexy (breast lift) raises droopy breasts from one to several inches and excess skin is removed. If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants.
A breast lift raises droopy breasts from one to several inches and excess skin is removed. If you just want to go bigger, the only way to do that is with implants. The great thing about these techniques is that they can now be down with minimal scarring and performed as an outpatient procedure without the need for general anesthesia.
When women with saggy breasts want to go bigger, I usually advise doing a breast lift along with the implants. Otherwise, the implants create what we call a “double bubble,” where the breast droops off the end of the implant like a sock. Some of my patients, however, don’t want a lift because they want to avoid additional scarring, so sometimes implants alone can fill out the skin and eliminate the saggy appearance.
Breast augmentation and breast lift (mastopexy)
There are a number of good reasons to do a breast augmentation separately from a breast lift procedure and it isn't just being surgically conservative.
Breast augmentation and breast lift are two different operations that do different things and have different risks and issues to get done and healed correctly while operating on the same breast. The two procedures tend to work against each other, both may not be needed (or another way of looking at it is that it's harder to judge the outcome), and the risk of complications requiring revision is higher than either procedure alone.
The only advantage to doing them together is that it costs less than doing them separately and there is one recovery instead of two. But if you need a revision to correct problems then you haven't saved much.
The two procedures should be thought of as completely separate and addressing different issues. An augmentation is adding pillow volume behind the breast. The minimum size increase is about one cup size and it does add forward projection and fill in the upper pole of the breast but it does not lift the breast. It can give the illusion of a lift by volume fill but does not correct true sagging (ptosis) of the breast. A breast lift (mastopexy) is generally only worth it if the breast is truly too saggy (ptotic) to allow for an augmentation. The lift will raise the position of the nipple-areola and if done properly will actually move the breast up on the chest but it will not add or subtract volume and will not give forward projection or fill in the upper pole. It also requires a vertical or lollipop incisional scar.
In general, if the breast is too ptotic for an augmentation and is at least a mid-B (average) volume then a mastopexy should be done first and the patient can then judge if an implant is still needed and can be done later with much more control and satisfaction in the size increase and what will fill out. If the breast is not too ptotic it can be augmented with a simpler procedure (aside from the implant) and will give a more controlled and predictable result.
Only if the breast clearly needs a mastopexy and is less than average volume is a combination procedure warranted in my opinion.
Breast lift and implants: one or two surgeries
Your surgeon is being conservative and there is nothing wrong with that. Generally this is classic teaching. However, most patients request one procedure due to down time for two procedures. In general the revision rate may be higher for one operation but most patients are pleased with the outcome. IF an agressive lift and large implants are being placed at the same time, then it may be preferable to perform two procedures to avoid excessive tension on the incisions.
Web reference: http://bodysculptor.com/lift.html
This is a controversial topic
Ask 3 doctors, you will get 4 opinions. The answer you will have to ponder, is your doctor's opinion. Some plastic surgeons do not feel comfortable doing both procedures together, others do. Also even those who like to do the 2 together will sometimes want to stage the procedures ( do two surgeries). So, if you trust your physician, and they have answered all of your questions go for it -- if not, get a second opinion.
Breast lift with augmentation
Doing the procedure will always be more accurate and safer when done in two stages. But this does not mean than one can't do it in one stage in a safe and accurate manner. The more the breast shaper and volume is changed, the more variation in end result so even if you do it in one stage, you should leave yourself open to the possibility of a need of a minor touch. If planned carefully, the lift and augmentation can be performed together safely in most usual circumstances.
It is safer to do it in two stages
Most patients want to have augmentation and lift at the same time because of the cost, recovery and anesthesia. The logic behind the two stage is ,the implants will inflate and stretch your breast and lift will tighten and gather the breast tissue. These two procedures counter act each other. The tension on the incision line,the blood flow to the nipple and also nipple position, all make the combined procedure more risky.
The only exception is when patient need only nipple lift(minimal lift) and even that will cause the flatting of the nipple/areola complex.
Breast Lift & Augmentation at the same time
Breast lift and augmentation are easy to do at the same time. The problem is achieving a truly cosmetic result. To do this at a single surgery, the surgeon must pre-plan the amount of augmentation properly, do the augmentation first, and then sit you up on the operating table to adjust the preoperative markings once the implants are in place. Many surgeons are either uncomfortable with this or unwilling to take the extra time and effort required. The advantage of this is one recovery and generally less expense. Anesthesia and the OR charge a set up fee for each surgery and you would only be paying this once if done at the same time.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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