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

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.

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 revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time.

in my opinion, the decision  to do the operation in a single or two  staged fashion becomes a judgment call made by a surgeon after direct examination of the patient.  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 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.

I hope this helps.

Web reference: http://www.poustiplasticsurgery.com/Procedures/procedure_breastliftaug.htm

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 when one is corrected at the expense of the other. Too big an implant, not enough skin removal or too much skin removal and not enough volume. Incisions require closure with the right amount of tension. The most common cause of wound healing problems is too big an implant. Smokers must stop smoking for a period before and after surgery. Some patients can obtain a C cup and others cannot. Good planning, excellent technique and reasonable patient expectations are the keys to a successful outcome with this combined procedure.

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.