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Confused - Does "Staging" Mean Separate Operations? (photo)

26 yr old anchor BL & sub-glandular BA. Want 2nd BL w/ rpl. implants (smaller & sub-muscular). Done in same operation, which should come 1st & why? If done in 2 which should come first & why? Should I find a ps who prefers to do them at different times & "could" that mean ps isn't skilled enough for both at once? How can I be sure either way? Having TT too, but BL & BA causing anxiety and fear of outcome & finding "right" ps for me. Was not happy with the 1st outcome shape, nor size. Thanks!

Doctor Answers (18)

Staging Implant and Lift

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    Staging suggests performing 2 or more surgeries to achieve a result.  I perform breast lift and augmentation with tummy tuck frequently, and this is appropriate for certain patients.  Kenneth Hughes, MD breast augmentation Los Angeles, CA

Los Angeles Plastic Surgeon
5.0 out of 5 stars 149 reviews

Staging breast surgery and tummy tuck

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Staging means separate operations.  However, from your photographs you need your implants removed and if desired new implants placed (smaller).  However, more important you need your breasts lifted.  You are a candidate for a new technique called The Ultimate Breast Lift.  Using a circumareola and inframammary incision it is possible to lift your breast tissue higher on the chest wall and transfer the weight of the breast to the underlying muscle.  This will increase your upper pole fullness, increase your cleavage and get your breasts higher on the chest wall where they belong.  The technique you had done resulted in a boat anchor shaped incision and the sub-glandular dissection cut the support to your breast tissue.  You are an excellent candidate for this new technique.  This operation would take from 4 to 5 hours and it would not be safe to undergo a simultaneous abdominoplasty since the surgery would last over 7 or 8 hours.

Best Wishes,

Gary Horndeski, M.D.

Web reference: http://www.horndeski.com/gallery.aspx

Texas Plastic Surgeon
5.0 out of 5 stars 109 reviews

Revision Breast Lift / Mastopexy with breast augmentation

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As I understand from your question, you have already had a subglandular breast augmentation with a breast lift / mastopexy and are seeking to have a more youthful appearance than was achieved during the first procedure.   Depending upon how much soft tissue that you have over the implant then switching to a submuscular position may not offer any real advantage.   You need to have a revision of the mastopexy so that the distance from the notch above your sternum to the nipple is approximately 21 cm.   

Atlanta Plastic Surgeon
5.0 out of 5 stars 7 reviews

A breast lift revision & augmentation can/should be combined into a single operation

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As others MDs have noted, staging does mean two separate operations. Based on your photos and assuming that you're healthy enough to undergo sedation/surgery (e.g. don't smoke, BMI below 30, etc), there should be any need to stage your breast lift, implant replacement and/or tummy tuck. Doing so not only increases costs (2x anesthesiologist fee, facility fee, etc) but also means 2 separate recovery periods.

Combining your implant replacement & mastopexy also mitigates the potential for overly tight or overly loose breasts that don't match up with the size implant/fill you want. In other words, it sometimes is the case that too much skin is trimmed away during the initial mastopexy procedure, leaving breasts that are too tight (or too loose) to accomodate the implant size needed to achieve your desired size/shape. 

I personally use a "staple first" breast lift technique in which I:

  1. Place the implants into a submuscular or dual-plane position first (or in your case, after removing the old implants
  2. Drape the breast skin around the implants & staple the into place 
  3. Mark and make my incisions (following the path laid out in the previos drape & staple step)
  4. Close everything up after making all necessary adjustments

I've had great success with this approach, especially in cases like yours where the patient is transitioning from subglandular to submuscular implants. The advantage is that it allows me to visualize the final 'combined' result before making a single incision.

So seek out a few plastic surgeons who not only have significant experience combining these 3 procedures into a single operation but also have before & after photos that you find appealing.  

Web reference: http://gallery.delucaplasticsurgery.com/before-after-surgery-galleries/breast-lift-vertical-mastopexy-with-augmentation-tummy-tu

Albany Plastic Surgeon
5.0 out of 5 stars 90 reviews

Staging of operations

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Staging an operation means to have more than one operation to eventually meet your goal.  This is done for a variety of issues.  Different surgeons will approach a problem differently.  It is not a matter of who is "right".  It is more of what that surgeon's experience and training is telling him/her to do in your individual case.

Web reference: http://www.jjrothmd.com/before-after/category/breast-lift-with-augmentation

Las Vegas Plastic Surgeon
4.5 out of 5 stars 7 reviews

Staging

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Yes staging means having the two operations breast augmentation and breast lift at two different times. This is sometimes performed when outcomes are not predictable.

New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Staging Breast Implants and lift

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Yes, staging means doing a procedure as more than one surgery on different days. It is one way to control the final outcome when there are things which may not be predictable.I personally perform breast implants together with lift. There are surgeons who prefer to do them as separate  operation to see how much sagging you will get after the lift. The implant adds to the risk for sagging by adding more weight.

Web reference: http://www.lakeshoreplasticsurgery.com

Chicago Plastic Surgeon
4.5 out of 5 stars 19 reviews

Confused - Does "Staging" Mean Separate Operations? (photo)

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Your personal situation is to much involved to discuss via the internet and especially without an in person examination. But to respond to the exact question. STAGING means separate operations. 

Miami Plastic Surgeon
4.5 out of 5 stars 56 reviews

For a redo breast lift, the vertical technique is most effective.

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Your concerns are justified.  First of all, the anchor lift is not the best in terms of either breast shape or scarring (or safety for that matter).  Looking at your photos, I agree that you still have substantial sagging.  The good news is that your scars heal nicely.  I would perform a vertical lift.  This will also make your breasts smaller (and shorten your horizontal anchor scar).  You might be able to keep your original implants.  There is no need for staging, which means extra surgery, expense, and time out of your life.  Experienced plastic surgeons using the vertical technique can replace implants and do a "secondary" lift at the same time.  Plus a tummy tuck.  Make sure you have an experienced plastic surgeon who is comfortable doing combined procedures and who uses the vertical (lollipop scar) technique (some believe that you cannot redo a breast lift using a different technique but it can be done safely by experienced surgeons).  There are examples on my website, and I've attached a link.  I tend to replace implants first when performing combination procedures, before going on to the breast lift and tummy tuck, simply because complete sterility is vital when inserting implants.

Web reference: http://www.swansoncenter.com/content/ideal-breast/procedures/breast-lift/patient-photographs.asp

Kansas City Plastic Surgeon
4.5 out of 5 stars 28 reviews

Breast Augmentation/Lifting in Single or Two Stages?

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Thank you for the question and pictures.

Whether the breast lift and augmentation should be done at the same time  is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately (staged) 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 increased 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 in 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.
Ultimately, I think you will be best off selecting the plastic surgeon who you feel will most likely be able to achieve the results you are looking for and follow his/her recommendations.


I hope this helps.

Web reference: http://www.poustiplasticsurgery.com/Procedures/Procedure_breastLiftAug.htm

San Diego Plastic Surgeon
5.0 out of 5 stars 628 reviews

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.