After weight gain/loss I now have 1 breast about a C? and one D/DD? both sagging. No children yet. Had 2 consultations, both reputable drs, first said under no circumstances to do lift & implant together because my skin is too thin and would scar and sag. He recommends 2 surgerys 1 year apart, 2nd said yes implant/lift could be done. I'd like to end with both breasts lifted around D/DD max. I've scheduled another consultation but can't get in for a month and am looking for some direction.
Breast Lift + Implant Later Vs Lift and Implant Together?
Doctor Answers (20)
Breast Augmentation/Lifting One or Two Stage?
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 lift with augmentation - 1 or 2 stages?
There is much controversy regarding breast lift with augmentation. Some plastic surgeons never perform the 2 together, citiing too high of complications and revision rates. It is true that breast augmentation and breast lift alone have much lower complication and reoperation rates than the combined procedure. In a difficult case of thin skin and asymmetry, it is not unreasonable to stage the 2 procedures. However, another way of looking at the problem is that if you do the procedures separately, you will have a second operation 100% of the time; whereas, if you do the combined procedure, you may have a second operation 25 - 30 % of the time. Additionally, the second procedure would likely be a revision in retightening the skin, since it is already thin and minor revision mastopexy which is a lesser procedure than either breast augmentation or breast lift is alone.
Breast implant and mastopexy
Surgeons will have differing opinions as to whether or not a breast augmentation should be performed at the time of mastopexy. Although there may be more chance of complications when these procedures are performed together, in many patients it can be done without inordinate extra risk. Issues such as significant size discrepancy and very thin and attenuated tissues such as with significant weight loss can create more problems. A beast lift with small reduction on the larger size would allow maximum skin tightening and breast symmetry. This could then be followed with an augmentation in six months using the same size implants which would afford the best symmetry with the least risks of perioperative complications. If symmetry is to be achieved in your case in a single operation, either different size implants need to be used or a breast reduction needs to be done on the larger side. Neither of these solutions are ideal. Although it is more inconvenient and somewhat more costly, staged procedures are at times more prudent.
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Would you be happy with a C cup?
You are caught in the controversy between those who are adamant about never combing these procedures and those who KNOW it can be done together (although risks for less than perfect results are higher).
Since you've not had children yet and I assume would like someday to be able to have them, my suggesting is to simply have a Rubin Mastopexy where you will be made more even, perkier and theoretically should still have the ability to breast feed if and when that becomes an issue. But you would have to be happy with a C cup which I would think would be okay for the majority of young ladies. Don't forget that as you age and gain weight, you will often gain some weight in your chest too. Finally, you avoid all the potential risks of implants but you will have to accept the scars that would come with such an extensive breast lift.
I hope you are able to find the solution that will achieve your goals.
Breast lift with implants
Breast lift (mastopexy) surgery is often performed at the same time as placement of implants (augmentation) in appropriately selected patients. Since you have not had any children yet you may want to consider the possible benefits and risks of doing these procedures (together or separately) before childbearing as your breasts will change with pregnancy and breastfeeding.
Breast lift with augmentation - 1 operation or 2?
My general approach to relatively large asymmetric breasts with ptosis (drooping) is to perform a differential inferior breast reduction through a vertical approach and place submuscular implants to create superior fill and cleavage.
By placing the implants in a submuscular plane you are establishing a situation where they will not descend appreciably over time unlike a prosthesis placed subglandularly. The inferior pole reduction treats the asymmetry and also removes breast tissue from the area where you do not want it. I have found over the years that a single operation does the trick (even in the most difficult cases) whereas the costs of staging greatly outweigh any possible benefits. If any re-operation is necessary after the combined procedure, it is usually not of a significant nature.
It is good that you are getting a third opinion and make sure they show you photos of how they handle a case similar to yours. Good luck!
Breast lift and augment together
it sounds like you have asymetry and want to go quite large. i would suggest two operations when a large implant is involved. i would do the mastopexy first and equalize the breasts. then i would do the augmentation 6 months later, when i could also touch up the mastopexy. i think this is the safest way to proceed. i believe the secondary operation rate for all comers for an augment-mastopexy is about 40%
Breast lift with implants
A breast lift and augmentation are usually performed as one surgery. However, if a women has severe droop (ptosis), staging (performing the lift in one surgery and then placing implants at a second procedure months later) is often used. However, my preference is to use just one procedure unless a patient has a significant amount of breast tissue.
Breast Lift with Implants
When done by a surgeon who takes the extra time to sit you up during the procedure and adjust the lift after placing the implants, the re-do rate is minimal and the results excellent. You require even more planning because of your asymmetry. Pick a surgeon with significant experience in both these aspects.
Breast lift with implant should be done together.
I don't think this is very controversial among experienced surgeons. This is about the correction of breast asymmetry, and not just about combining breast lift with breast augmentation. But in any circumstance, these two procedures are best done together. We do them together very frequently, with a very low complication rate (no higher than when done separately).
It seems that you need a vertical breast lift (Lejour or Hall-Findlay technique with a lollipop scar) with no implant in your larger breast, and a similar lift with an implant for symmetry in your smaller breast. And of course these procedures need to be done together, so you have the best chance of getting a symmetrical result.
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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