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

                  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. 

Web reference: http://www.realself.com/question/breast-lift-scar-and-implant-concerns#1251861

Web reference: http://www.jjrothmd.com/procedures/mastopexy-breast-lift

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 to be performed in making a recommendation on sizing.  I generally recommend the combined operation to patients who have very little upper pole volume and who need an implant to create the breast contour that they are looking for.