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.

While breast augmentation lift surgery can be performed in an one stage manner, there are always limitations, tradeoffs and risks that one has to consider based on a multitude of factors including patient's tissue quality, preferences and surgeon's skills & experience.

It's difficult to advise without seeing any photos but in general doing a breast augmentation lift procedure in a two staged approach is a lot more controlled, reliable and "risk less" depending on the degree of upsize that you desire as well as the magnitude of tightening and lifting that is necessary to achieve the optimal surgical outcome that is right for you.

Always remember breast augmentation lift is a much more complex procedure to get right, whether performed in one or two staged approach. It has a significantly higher revision rate compared to either breast augmentation or breast lift alone. It's important to bear in mind there are competing factors that the surgeon is trying to negotiate, ie. trying to upsize your breasts with reasonable sized implants while tightening your breast skin envelope at the same time before determining the degree of lift that is suitable for your breast & nipple areolar proportions and dimensions. Achieving the right balance between all these factors but at the same time the right tension to acquire the ideal "look" & "feel" that you desire requires a lot of careful planning and consideration from your surgeon. 

My advise would be to adhere to your surgeon's recommendation provided you understand the reasons behind it, or else it may not be a bad idea to seek a second opinion from another fully qualified specialist plastic surgeon for further advice before making your final decision.

Hope that helps.

Best wishes

Ellis Choy

Performing both a lift and augmentation at the same time is difficult and requires an experienced surgeon. The bigger the implant you choose, the less lift you will need. If you decide to go very large, you may not need a lift at all. I always do the augmentation first to get the size and volume you desire and selected pre-op, then I elevate the head of the OR table (during the surgery) to see how much of a lift you need. It may be a simple "half moon" scar above the areola or the full anchor scar for a mayor lift. After 30+ years I can fairly accurately predict how much of a lift you will need for the implant size you chose, so you have a good idea of the scar to expect.