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Do You Need Two Surgeries for Breast Lift and Augmentation?

The doctor told me that with a Breast lift and a Breast augmentation done in the same surgery/same day, I could only go to a B cup. Or I could have two surgeries, one to have the Breast lift and then the second one for the augmentation, where I could have any size implant put it.

The reason for this is so they don't have to worry about closing up tight skin around a big implant. I have never heard of this before. Does the size or your breast before the implant affect how big you can go?

Asked 25 months ago by Ann0225 in Tampa, FL
Sort 31 expert answers by:
+2

Breast augmentation and lift, 1 or 2 surgeries

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... more
Brent Moelleken, MD
Beverly Hills Plastic Surgeon
+2

Breast Augmentaton and Breast Lift in One or Two Surgeries

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.
Christopher L. Hess, MD
Fairfax Plastic Surgeon
+2

Your surgeon's advice about a breast lift/augmentation is very wise!

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... more
Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
+2

Simultaneous or staged augmentations and breast lifts

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... more
Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
+1

Simultaneous augment/mastopexy

It is quite common to perform a lift and augmentation in one operation. Your starting size is a factor in how large you can go in terms of augmentation. Because the lift removes excess skin and tightens the breast, there is a limitation in how large to augment the patient. Remember that too large an implant, after the effects of gravity and in a patient with skin laxity, may result in subsequent sagging and the need for reoperation. There is a definite balancing act... more
Robert L. Kraft, MD
New York Plastic Surgeon
+1

Breast lifting and augmentation simultaneously/

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... more
Tom J. Pousti, MD
San Diego Plastic Surgeon
+1

Breast Lift and Breast Augmentation

This is a subject that is often discussed among plastic surgeons. I feel that this combination surgery can be safely performed with good results when the patient is well informed and has realistic expectations. This is not an all or nothing operation but is a compromise of two procedures to minimize and achieve good wound healing. The two problems are excess skin and inadequate breast volume. The breast lift removes excess skin and a breast implant provides volume. Problems arise... more
Richard Linderman, MD
Indianapolis Plastic Surgeon
+1

One Surgery or Two

Most patients who desire a lift and an augmentation can be treated with one procedure. We prefer to utilize saline implants in many patients seeking upper pole fullness, when performing this procedure.
Marc Schneider, MD
Fort Myers Plastic Surgeon
+1

2 surgeries for breast lift and implantation is probably the safest way to do this combined operation

Your surgeon is correct in suggesting 2surgeries for a breast augmentation and lift. Many of the common complications of breast augmentation with lift can be avoided or minimized when the surgery is performed in 2 procedures.
Dev  Wali, MD
Los Angeles Plastic Surgeon
+1

1 or 2 surgeries for breast augmentation and lift

The shape of the breast is determined by the volume of breast tissue and the skin envelope. It is common to place an implant under the breast tissue and remove skin to lift the nipple, resulting in the desired shape. However, a breast augmentation with a very large implant needs to be placed first and then determine the amount of skin to be removed. The decision to proceed with a one stage procedure is individual to each patient and their surgeon. Previous scars on the breast can affect... more
Andrew Turk, MD
Naples Plastic Surgeon
+1

Single surgery vs two surgeries

Ann0225, Breast lift and augmentation is an operation that can be very tricky. Let's think about it. An implant is placed to increase the breast size while a breast lift tightens the skin to lift the nipple which decreases breast size. Single Surgery (one stage) You have two different operations with to different purposes combined at the same time. If the implant is too large and lift is done in which the skin is very tight then this could produce significant healing problems of the... more
Earl Stephenson Jr., MD, DDS
Atlanta Plastic Surgeon
+1

Breast augmentation and lift can be done at the same time, just carefully

Breast augmentation with lift can be safely done at the same time, but the augmentation should be done first to ensure that the correct amount of skin is removed to allow for closure of the incisions without too much tension. If you are thin and your skin is tight over your breast, it is possible that you will not accommodate a large implant safely at the same time as the lift. This is a judgement that can only be made in person based on physical examination and the surgeon's experience.... more
Elizabeth Lee, MD
Bay Area Plastic Surgeon
+1

Breast lift and augmentation can be done together or separate

A breast lift and augmentation can be done either in a staged fashion, or as a single procedure. The trick to doing it in one setting is putting the implants in first and then marking for the lift. This is one of the trickier operations in plastic surgery today. Your consulting surgeon sounds very conservative, which is not a bad thing, just a point on the surgical spectrum and another way to "skin a cat." Good luck!
Kenneth R. Francis, MD
Manhattan Plastic Surgeon
+1

Your breasts can be lifted as well as made bigger...but it may take two surgeries

Hello - Your plastic surgeon is right.  If you would like much larger breasts with a lift, you may need to wait in between surgeries to prevent problems with closing the skin.  However, if you desire more of a lift with a little increase in volume, both can be done simultaneously.   Good luck!
Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon
+1

Does the size or your breast before the implant affect how big you can go?

Yes. Of Course it does. To get the BEST looking breast Augmentation possible (instead of a fake appearing "boob" with obvious ripples that falls sideways) several factors need to be considered, the most important of which are the amount of breast tissue you have RIGHT NOW to cover your chosen implant AND the size of the flat portion of your chest which will support your implant. There is NO perfect breast implant and ALL breast implants when held upright will form ripples (this is... more
Peter A. Aldea, MD
Memphis Plastic Surgeon
+1

Breast lift and implant augmentation: one surgery or two?

This is a matter of opinion and experience. You have been informed of the traditional and conservative method of breast lifting and augmentaton carried out in two operations. The argument for performing them at one time is an increased risk of revision srugery. However, most patients, when given the choice, would prefer this option and take a chance of needing a second surgery as opposed to the approach where two operations are guaranteed.
Otto Joseph Placik, MD
Chicago Plastic Surgeon
+1

One or two stage breast lift and augmentation

There is a lot that goes into an augmentation and a lift, but I do them together. Most patients do not want a staged procedure if it can be avoided.
Steven Wallach, MD
Manhattan Plastic Surgeon
+1

Do the lift first if you are undecided about an implant

If you are interested in a breast lift, and want a natural-looking smaller breast augmentation, there are breast-lifting techniques that can both lift and augment the upper pole of your breast without an implant. Obviously, these procedures don't make the breast bigger, they just redistribute some of your breast tissue to the upper pole. I tell patients that if they are on the fence about an implant but want a breast lift--do the breast lift first. Several patients have been happy enough... more
Scott Sattler, MD
Bellevue Plastic Surgeon
+1

Breast lift with augmentation, one or two stages

I have performed this operation both in a single, as well as a 2 stage operation. Each case is defferent, and part of the decision is based on the goals and the quality and health of the patient's tissues. You might want to get a second opinion and weigh the risks and downtime of one versus 2 operations.
Darrick E. Antell, MD
Manhattan Plastic Surgeon
+1

Breast lift and implants together: pros and cons

As you can tell from the answers already posted, there is a healthy debate about doing the two operations together. On the con side, both operations are individually not simple, and doing them together multiplies the complexity. That means that revisions afterwards are more likely to be needed. On the other hand, doing them in 2 stages automatically means 2 surgeries, with the possibility still remaining of a third if a revision is needed. In my experience, doing them as one makes the... more
Richard Baxter, MD
Seattle Plastic Surgeon
+1

Breast Augmentation, Lift, and managing RISK

It is much safer to stage breast lift and breast augmentation operations, especially if you are hoping to achieve a very youthful / full appearance. Look at the last patient in my video. We performed her operation in a staged fashion to achieve her result in a safe manner. If she were to undergo a combined operation, risk would be much higher, and the result would not be as good. When a surgeon performs a breast augmentation, the implant is pushing outwards against the skin envelope. ... more
Michael A. Bogdan, MD
Dallas Plastic Surgeon
+1

Two Operations Can Be Safer

Tightening a breast with a lift, and enlarging a breast with an augmentation have inherent contradictions. The breast tissues may not hold up to doing all of this surgery at once. Lesser lifts, such as a crescent lift around the areola, can easily and safely be combined with an augmentation at the same time. A bigger lift for a droopier breast, or a bigger augmentation size demands some patience on your part in the interest of safety. There is a lot of safety in separating the operations... more
Keith Denkler, MD
Marin Plastic Surgeon
+1

Breast lift and large implants

I agree 100% with what has been said here. A large, heavy implant may make it difficult to close the skin, and will undoubtedly lead to a shortened lifespan of your lift with early "bottoming out." Weight loss patients with loose skin, older individuals with thin skin, and those with very long breasts do better having just a lift done first, then adding implants later.
John LoMonaco, MD
Houston Plastic Surgeon
+1

Breast lift/implant combination is very common

As you can tell, there are a lot of different ways to approach this issue. Surgeons that do the combined procedures have seen problems with the combined procedures and have probably learned how to manage the risks. Those that gave it up have done so with their best judgement. In all honesty, I can tell you I have been through my learning curve and feel pretty comfortable with doing the implants and lift in a combined procedure. There is a higher revision rate with unlevel healing of the... more
Marcus L. Peterson, MD
Saint George Plastic Surgeon
+1

Breast augmentation with a combined breast lift: One stage or two stages

The decision to combine a breast augmentation with a breast lift in one operation, or to do it in two operations, depends a lot on your anatomy and what your surgeon's particular experience and judgement is. In general, the less of a lift you need, and the smaller the implant you want, the safer it is to do both together. If you want a bigger implant and need more of a lift, then the risk of poor blood supply to the nipple or poor healing in general, goes up. Some surgeons always do them... more
Shahram Salemy, MD
Seattle Plastic Surgeon
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