Do You Need Two Surgeries for Breast Lift and Augmentation?

Plastic surgeon's face a frustration that no other surgeon faces: responding to patient's wishes. No heart patient tells a cardiac surgeon how to operate, but plastic surgery patients are always pressuring their surgeon to do somethng that goes against their best judgment.

In general, lift and augmentations can be done at the same time. But there are trade-offs in doing it. No one can give you a steadfast rule about when it is and isn't wise to do them simultaneously versus staging them in two operations. Generally speaking, the greater the droop, the thinner the breast tissue, and the larger the implant, the safer, more accurate, and most consistent outcome is likely to be achieved doing a staged operation.

If your surgeon told you that, stick with his or her advice.

BUT - and this is a BIG but ---you should think carefully about your request for the "big implant" you wrote that you want. Stop and think aboiut it: though skin is removed with a lift, the skin that remains is the same poor quality skin that has already failed to support the weight of the breast. Adding more weight is therefore fundamentally illogical. We do it, and we can get good results, but the best long term results are achieved if the patient and surgeon are prudent about the implant size and WEIGHT. Remember, an implant has weight, not just volume!

If you ask around enough, you'll find another surgeon that tells you that he or she can do it in one stage. I assure you there is no secret technique that the person proposing a one-stage surgery possesses. It is a matter of how they weigh risk and how enthused they are to get you to schedule surgery with them on your terms.

Let me be clear: it can be done in one stage. But if a thoughtful surgeon has told you - based upon their assessment of your tissues, your implant size, as well as your expectations for the absolute perfection of the surgery - that you should do it in two stages, you would be wise to heed their advice.

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

It is true that doing a breast lift and breast augmentation in two settings is far safer from a blood supply standpoint. This has been well established. However, doing them together can be done safely.

Greater surgical skill is required to perform an augmentation mastopexy at on setting then at two settings. But it is possible and does occur tens of thousands of times per year. A skilled surgeon with experience can perform this surgery successfully in one setting.

As many of my esteemed colleagues have noted, there is a lot of judgment in deciding whether the procedures should be done at the same time or different at two different settings.

Factors such as the health of the tissues, the thinness of the tissues, the difficulty of each procedure, whether they are revisional and what blood supply still exists after prior surgeries, the looseness of the tissues, the health of the patient as a whole, the patient's expectations, etc. all factor in. The big concern is that the nipple will lose blood supply and die, which can happen if too aggressive a surgery is performed. This is a complication that is usually avoidable by staging the surgeries, so the stakes in this decision are high.

Of course everybody wants the surgery in one setting. An experienced plastic surgeon can guide you through which choice is better.

The degree of lift you need depends on how far down the nipple has gone and if it points down or forward.

If your nipple is above the lowest point of the crease below your breast and points forward, you can have a periareolar lift (just around the areola) and basically go with any size implant.

If your breast needs a full lift, however, the lift tightens you and the implant stretches you and these can cause complications if either is too much. So, there is a limit on how big you can go with a one stage procedure. If fact, while I usually do one stage augmentation mastopexies, just 5 minutes ago I told a patient she needed to stage the two because the size of the implant she would need was too big for the lift to handle. She'll wait 3-4 months between the two surgeries.

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

Breast lift with augmentation is a very powerful and safe operation to overcome the "deflated" look many women experience following pregnancy or with significant weight loss.

In my practice, I most commonly perform this procedure in a single operation.   That said, there are several variables among patients that might create the need to stage this procedure into two separate operations.  These include the severity of ptosis(drooping), thinness of skin and breast tissue, smoking history, and size/reshaping aesthetic goals.

This decision can only be made after a thorough consultation with a board certified plastic surgeon(or two). It  sounds as though your surgeon falls to the conservative end of the spectrum here, but I believe you are getting solid advice.

If it is performed by a skilled and experienced surgeon, breast augmentation and lifting may be performed in the same operation.  Recently we published our experience with 1,192 of these procedures performed at the same time.

Web reference: http://aes.sagepub.com/content/34/5/723.abstract

Usually, breast augmentations and lifts can be done in one surgery. There may be certain concerns that your plastic surgeon has, and for this reason he/she has recommended two separate procedures. If you do not agree or feel uncertain with your current plastic surgeon, seek a second opinion.

Hello! Thank you for your question! These two procedures can be  effectively and safely performed in one setting.  Staging the procedures to have them performed at various times will likely not have any cost benefit for you. When you combine procedures, there is often a discount that is provided by the surgeon for multiple procedures. Also, when having multiple procedures performed at the same time, you save on anesthesia and facility fees, which otherwise are paid for with each individual procedure. In addition, you may benefit by the single recovery time. However, your plastic surgeon will have to determine for you if the viability of the breast as well as nipple-areolar complex may be placed at jeopardy if done at the same time. For this reason, it would be wise to stage these procedures.  It is true that larger implant will place increased tension on the overlying breast tissue and may compromise the integrity of the skin.

Certainly it is you decision as to whether you have your procedures performed in one or multiple stages, but your surgeon will give his/her recommendations. I would discuss your concerns with your surgeon and see what your options are. Hope that this helps! Best wishes for a wonderful result!

Breast lift and augmentation can be safely performed in one surgery and is the most common way that I perform the breast lifts in my Raleigh practice. It is quite possible to deliver a size larger than a B cup if the patient has good tissue, skin integrity and is a nonsmoker.

Best of luck,

                  The decision to perform breast augmentation and breast lift in combination is dependent on a multitude of variables. Anatomic factors such as chest wall shape, skin thickness and the amount of skin sag are all important considerations. In addition, aesthetic considerations such as implant size and style are important as well.

                  Depending on these variables a decision may be made to perform a single combined procedure or stage the components of the procedure. When these procedures are performed simultaneously, there may be limitations on the size of the breast implant utilized. Larger implants can cause pressure on the overlying muscle and skin flaps. This in turn has the potential to damage blood supply to the nipple areola complex and cause skin necrosis. In addition, large implants can cause tension on the wound closure, which might cause wound breakdown and spread of the scar. For these reasons, most plastic surgeons don’t perform breast lifts when larger implants are utilized.

                  When moderate sized implants are used, breast lift and breast augmentation can be performed together without difficulty and patients report high satisfaction rates.

                  It sounds as if your plastic surgeon has given you good advice. It’s important that safety be everyone’s first priority.