Breast Lift & Implant. 1 Surgery or 2? (photo)

I'm 31, have nursed 3, weigh 125 & wear a 34C. I want tight, round, perky breasts (small implant, remain C or small D). I've visited 2 doctors & been given 2 different diagnosis. #1 I need a lollipop and implants in 1 surgery. #2 I need an inverted t and stage the surgeries. Does staging the surgeries result in better (less) scarring on the vertical scar? Would my areola stretch if i do 1 surgery? Would a lollipop raise me enough? Is scarring worse with a lollipop b/c the weight of the implant?

Doctor Answers (23)

Delayed breast lift after augmentation is conservative but has advantages

+3

Thank you for your question and photographs. Although 1 stage breast lift and augmentation is very commonly performed, there is still as you in the delayed approach.

Having your breast augmentation first gives you the possible benefit that you may not need a breast lift if the initial augmentation give you the results you want without significant ptosis or deformity. This is a significant potential benefit.

Many plastic surgeons believe that allowing the breast implant to fall and assume its final shape and position allows for a more accurate nipple placement during the breast lift procedure.

As always when deciding to have plastic surgery I recommended patient is trust there got feelings and instincts when choosing between 2 plastic surgeons.


Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast Augmentation with Mini Ultimate Breast Lift is the one operation to satisfy your needs

+1

There is a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to lift your breast tissue higher on the chest wall, reshape your breasts to increase upper pole fullness and displace the breasts more medial to increase cleavage.  This will increase the projection of your breasts by aligning the areola, breast tissue and implant high on the chest wall over the bony prominence of the chest.  I never use the Wise pattern of the lollipop or boat anchor shaped incisions.  Circumareola approach leaves less scars to accomplish your goals in one operation.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
5.0 out of 5 stars 119 reviews

"Lollipop" breast lift + implant: 1 surgery or 2?

+1

On reviewing your photos, you are an ideal candidate for a vertical “lollipop” mastopexy with a small implant.  The small implant would give you more fullness in the superior pole and the mastopexy would elevate the nipple/areola complex. 

In your case you have glandular ptosis and one of the important aspects of a vertical mastopexy is resection of inferior breast tissue.  This tightens the inferior pole and supports the newly elevate nipple/areola complex. 

I have always questioned the rationale of the two staged mastopexy procedure. 

First off, the inferior T technique creates and infra-mammary scar which in the vast percentage of patients is unnecessary.  You do get skin excision in the inferior medial and lateral quadrants of the breast, but that is easily matched in a vertical mastopexy with the central skin and breast tissue removal. 

I have found over the years that the invert T approach is certainly appropriate for massive weight loss patients with third degree ptosis and extensive redundant skin.  In those cases, it is difficult to correctly judge the placement of the implant to create the new mound with the extensive elevation of the breast that is necessary. 

In those cases when a small implant is utilized, a single stage is still my preference.  But when a large implant is desired then staging would certainly be reasonable. 

You do not fall into this category and are actually the ideal candidate for a one stage procedure. 

In an experienced surgeon’s hands, revision rate for an augmentation mastopexy should be in the single digits.  With a 2 stage procedure, you are essentially creating a revision rate of 100%.

William F. DeLuca Jr, MD
Albany Plastic Surgeon
5.0 out of 5 stars 105 reviews

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Lift augmentation

+1

Hello. I would recommend a lift and augmentation in one procedure with the lollipop approach. I do these procedures regularly with none of the complications you mentioned. As a matter of fact the lollipop approach would cause less scaring than the inverted t approach and would be perfectly adequate to raise the breast. The only time that I would recommend staging this kind of procedure would be to correct grade three ptosis, which judging by your pictures you do not have.


Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 24 reviews

When is a delayed lift necessary?

+1

The reason for your surgeon to recommend a delayed lift is for safety.  When large implants are placed in the breast, it can cause significant tension on the overlying tissue, particularly the nipple.  When a lift is performed, an incision is made around the nipple- in all types of lifts.  This incision prevents blood from the surrounding skin from getting to the nipple, and therefore the blood supply to the nipple is required to be from the underlying tissue.  This is usually not a problem at all, but if a large implant is applying a lot of pressure from underneath the nipple, the blood vessels can be squeezed closed, and this blood supply can become insufficient.  

If there is not enough blood to your nipples after surgery, they can die, and this is a rare but dreaded complication.  I have never had this happen to me but I have seen photos from colleges, and I always want to be conservative to avoid this complication.  

So, if your surgeon is placing a relatively small to moderate sized implant that is not going to put excessive pressure on your nipple, a single stage operation is very safe and a lift can be done at the same time as your breast implant.  If, however, your plan is for a large implant, my advice is to do the surgery in 2 stages- let the blood supply stretch out and accommodate to the new implant for about 3 months.  After that, the incisions around the nipple should be very safe to do as the underlying blood vessels will no longer be under excessive tension.

I hope that answers your question- good luck and congratulations on your upcoming surgery.

Adam David Lowenstein, MD, FACS
Santa Barbara Plastic Surgeon
5.0 out of 5 stars 22 reviews

Lift

+1

You have minimal ptosis. A well sized implant will give you the results you are looking for as far as volume only. You will need a periareolar lift for the final touch up which can be done at the same time

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast Augmentation Mastopexy

+1

Augmentation mastopexy is designed to correct the two most common changes that occur in breast appearance following pregnancy: loss of breast volume, and stretching out of breast skin. While there are some moms who can get an acceptable cosmetic result from augmentation alone or from mastopexy alone, many moms have a combination of breast volume loss and skin excess that requires simultaneous augmentation and mastopexy (breast lift). I frequently perform this surgery in concert with an abdominoplasty (tummy tuck), and this combined breast and tummy rejuvenation surgery is sometimes referred to as a 'mommy makeover'.

Augmentation mastopexy is also commonly performed for major weight loss patients, including those who have had bariatric surgery including gastric banding and gastric bypass. Obesity followed by major weight loss usually produces breast changes that are very similar to those seen after successive pregnancies, and often the effect on breast skin is quite severe. Additionally, as a North Carolina breast implants surgeon, I regularly see patients with significant breast ptosis (the medical term for 'droopiness', pronounced TOE-sis) in young adulthood, without any history of pregnancy or major weight loss. Some breasts are just naturally droopy, and I have performed mastopexy and augmentation mastopexy for patients as young as 21 years.

This surgery is a potentially challenging one which requires thoughtful preoperative evaluation and planning, and careful attention to detail in the operating room. Many surgeons have traditionally performed breast augmentation and mastopexy surgery in stages, usually mastopexy first followed by augmentation at a later date. In the recent past more and more surgeons have adopted a non-staged, single surgery approach to augmentation and mastopexy, and that is what I propose for the vast majority of patients who I see in consultation that need both procedures. I believe that the results of simultaneous augmentation mastopexy are as good or better than a staged approach in most cases, and of course patients quite naturally prefer a single trip to the operating room if at all possible.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 37 reviews

LIft and augmentation?

+1

If you want more volune you would need an implant. It looks like from your photos that  you would need a lift. Depending upon the implant volume and your exam would determine what type of lift you would require.  Possibly a circumareola or a lollipop would be all that you would need. On occasion an anchor type incison is used, but I reserve that for patients with severe laxity.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

To lift or not?

+1

Based on your photos, it looks like your nipples are positioned above the fold of your breasts.   So it doesn't look like you need a lift at this time and implants alone should be able to provide a good result.   Your areola will probably stretch but they should be so big they need to be modified.   You don't need a inverted T or vertical or circumareolar scar. 

 

Find a board certified plastic surgeon that you trust with experience in breast augmentation and you should be fine.

Adam Hamawy, MD
Princeton Plastic Surgeon
5.0 out of 5 stars 13 reviews

Option #1 is Reasonable

+1

Thank you for your pictures.  I would agree with implants and a lift in the same surgical setting.  The scar would not be less with a staged procedure (typically).  What the best type of lift is determined by your physical exam.

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

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