I'm 5'6, 157 lbs, and D-DD cup. Can a lift and implants be done at the same time? (photo)

I have lost 230 lbs since 11/27/12. I would like to have both procedures done at the same time instead of under going 2 surgeries. I am 5'6 157lbs and would like to be a full D-DD with high profile implants.

Doctor Answers (12)

Two stages or one stage

+2
Congratulations on your weight loss - well done!!

Usually, I do combine breast lift and breast augmentation in one stage, except for a few exceptions.  One of these is the massive weight loss patient - anyone who has lost more than 100 pounds.

I would do your surgery in two stages:  first, a really good lift, then come back for the implant, and any adjustments to the skin envelope of the breast.  

Here's why:  your skin elasticity was very damaged when you were larger.  When we put an implant in at the same time as a lift, it won't be physically possible to remove as much of this damaged skin compared to a lift without implants.  And soon, this remaining damaged skin stretches out, perhaps worsened by the weight of a big implant.  Best to remove as much skin as possible, expect a little loosening, then go back and do touch-ups and implant later.


Orlando Plastic Surgeon
5.0 out of 5 stars 27 reviews

I'm 5'6, 157 lbs, and D-DD cup. Can a lift and implants be done at the same time?

+1
Breast augmentation with a lift would be a reasonable option at one time.  I have performed hundreds and hundreds of this combination without even a partial areolar necrosis . Find an expert in breast surgery who has great reviews and great before and after photos.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 209 reviews

Lift after weight loss

+1
With your weight loss, I suspect you have excess skin laterally on your chest (area is not seen on your photo).  To remove this excess skin with your lift will require the anchor incision. Some surgeons might suggest doing the augmentation separate from the lift.  Some of your excessive tissue might also be used to augment your breast. I would suggest seeing a board certified plastic surgeon, and discuss all your concerns. Before you have any surgery, you need your family care physician check your protein and albumin levels, plus your blood count, to make sure your labs are in normal limits. If your protein levels are too low, you might not heal well from surgery.

Connie Hiers, MD
San Antonio Plastic Surgeon
5.0 out of 5 stars 4 reviews

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Can a lift and implants be done at the same time?

+1
Thanks for your question and congats for your weight loss. Based on your pictures you need a large vertical lift (lollypop) with a breast augmentation to achive your goals. These two procedures can safely and effectively be performed in one setting with out any risk.

i always recommend to my patients to have these procedures performed at the same time not in stages, caus its save you in anesthesia and facility fees, which otherwise are paid for with each individual procedure. In addition, you may benefit by the single recovery time.

Best wishes !!

Manuel Marte, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 4 reviews

Two stages are safer and a great outcome is what you deserve

+1
Congratulations on your massive weight loss.  You certainly deserve the best henceforth.  Massive weight loss patients sometimes have difficulty wound healing because they may be nutritionally depleted.  Most PS will agree that concurrent breast implant and mastopexy is a difficult op because so many variables need to be optimized: 1. equal volume; 2. excellent scars; 3. soft mobile breasts; 4. longevity of the results; 5. minimal complications, such as delayed wound healing, etc.  Analyze your particular situation to control all variables which could compromise wound healing: a. diabetes; b. cigarette smoking; c. child care, which might involve lifting; d. get medical clearance from your bariatric (weight loss) team; e. consider removing the
left nipple piercing, because its metallic nature is incompatible with the electrocautery (the device needed to control bleeding vessels) and the tract may be colonized with bacteria, which can complicate any breast aesthetic surgery. 
By staging your procedures, wound healing should be vastly simplified and limited to one suture line, instead of the anchor pattern.  Additionally, your PS may suggest the addition of an ADM (acellular dermal matrix) to help support the weight of the implant, as MWL (massive weight loss) patients' skin is notoriously stretchy.
Completely agree with the choice of a high profile implant.  Best wishes for a fabulous outcome!

Lavinia Chong, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 39 reviews

I'm 5'6, 157 lbs, and D-DD cup. Can a lift and implants be done at the same time?

+1

Congratulations on your significant weight loss; you should be very proud of this accomplishment!  In your case, I would suggest that you have the breast augmentation/lifting procedures done in 2 stages. In my practice, I would offer you the breast lift (mastopexy) first; the breast augmentation procedure would be done several months subsequently. 

Some general thoughts may be helpful to you and other women considering this combination procedure. Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, 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.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation. I would say that, in most communities,  anesthesia on your and surgery facility fees (minimally) are patient responsibility,  when returning to the operating room for revisionary breast surgery.

 Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.
To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery.
I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. 
The use of the tailor tacking technique is very helpful.  Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
 Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts.  Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc).
 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity  of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately.
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.
Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.
 The attached link may also be helpful.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 727 reviews

Combination breast lft with implants after weight loss

+1
because of the severity of your ptosis and uncertainty of blood supply to the nipple I would recommend a two stage procedure.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 31 reviews

I'm 5'6, 157 lbs, and D-DD cup. Can a lift and implants be done at the same time?

+1
To me based upon your posted photo - NO! I would offer two separate operations in your case... Good Luck... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Combined lift and implants

+1
Many surgeon will do a breat lift at the same time as an augmentation. 

Others will not, so attend many consultations with board certified plastic surgeons, until you find the one you trust.

pretty simple and good luck.

John Sampson, MD
Jackson Plastic Surgeon
4.5 out of 5 stars 11 reviews

Breast Lift with Implants

+1
Hey, Congratulations on the weight loss.  Fabulous, just fabulous.  Some PS would suggest two stages for you, but most would  do just one combined procedure.  You would be a challenge, so be ready for a possible touch up, maybe. Here are some tips on sizing for you:This is perhaps the hardest decision for a patient to make, as well as the surgeon. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc. You can try on implants in the office by placing them into a special bra. Approximately 50 cc (1-2 oz.) is added to the final volume to account for flattening of the implant in the partial submuscular pocket. Once you decide on a size you like, then add on about 25-50 cc, because in real life the implant will be flattened slightly by your tissues. Multiple measurements need to be taken to fit an implant to your exact anatomy. Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer. Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan. Keep in mind larger implants tend to have more problems over the years. Since silicone implants wrinkle less than saline implants, they might be your best bet.

You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and see what you think.Implant size must square with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wall are taken (seven in total). Implant size selection has been an issue of much discussion.

Therefore, I use a wide variety of methods, but the implant size is always established preoperatively.Also, patients are advised to bring reference photos demonstrating their ideal size and shape. A photo album of patient pictures is maintained to assist them. These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery. In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover. Then, the patient’s verbal requests are factored into the analysis.Our average size over the last 6,000 implants was 350.

Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). Also, ask if they have an established, high volume breast augmentation practice, performing several hundred breast augmentations each year. Ask to see their before and after photos if you didn’t see any on their website. If they are experienced, they should have several 100 breast implant patients for you to view. I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you. You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.All the best, “Dr. Joe”

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 40 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.