Do You Need Two Surgeries for Breast Lift and Augmentation?
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?
Doctor Answers 42
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 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.
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.
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 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.
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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 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.
Do you need two surgeries for breast lift and augmentation?
Breast lift with implants
Breast augment/mastopexy done at the same time
Breast Augmentation and Lift, One Surgery or Two?
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.