How Does 2-step Mastopexy and Augmentation Look Different Than Single Step?

I don’t think a two-stage augmentation/mastopexy necessarily looks any different than a single stage procedure. Most patients (and many surgeons) prefer a single stage procedure because they have only one operation and recovery. Two stages may be preferred if there are concerns about nipple-areolar complex viability and/or healing. If a woman desires an augmentation, and appears borderline for needing a breast lift, then a decision may be made to do the operation in stages: perform the augmentation, allow the implant to settle into place, and then decide if a small lift is necessary.

It is important to understand that an augmentation mastopexy is a technically difficult procedure because the surgery involves doing two opposing things to the breast at the same time – the augmentation makes the breast larger and increases the surface area of breast skin, while the lift makes the breast more compact and decreases the surface area of breast skin. Surgical planning has to account for these changes and that can be challenging.  Revision rates are, therefore, usually higher following single stage procedures. Surgeon experience is important in obtaining a satisfactory result.

Some surgeons may feel that they have better control with a staged procedure. Usually the breast lift is performed first, and then the augmentation is performed 6-12 months later. When utilizing this staged approach, the size of the breast implant that can be used (for the second stage augmentation) is potentially limited by the amount of skin tightening that was performed during the breast lift (in the first stage). That is not necessarily a bad thing, as large implants make breast lifts more difficult and place more stress on the skin with a potential for more stretching and ptosis. For those patients who desire large implants and also need a lift, a single combined procedure may be better since the larger implants can be placed first, and then the skin tightened to shape the breast around the implant.

Your plastic surgeon should be able to make good recommendations and help guide you through the decision making process. Best wishes, Ken Dembny

I prefer to perform the procedure in two steps if the breast needs to be lifted more than about two inches.  Trying to achieve a good result in one stage is more risky and you are less likely to get s good result.  That means you may need s revision which turns it into a two stage procudure anyway.  If you only need a slight lift it can be done as a single stage procedure.

For reasons of soft tissue safety there might occasionally be indications for two-step mastopexy. Cosmetically, however, I don't see the advantage.

Thanks for a great question.  I do alot of single stage mastopxy-augmentations while many of collegues do not.  I do however have a ceiling on the amount of ptosis (drooping) I am willing to correct in a single step procedure.  If you have significant ptosis (nipple is greater than 6 cm from its correct position)  it can argued  that a staged approach is safer with less nipple compromise.  In terms of aesthetics, I think doctors who do lifts with augs together all the time can get excellent results either way. 

           I prefer to perform the augmentation and lift at one time, because I get predictably good results without complications and the patient undergoes only one surgery.  I do not think that results are different.   Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Properly done, in most settings there should not be a difference. (Improperly might be 600cc implants in tight skin needing nipple elevation.)

There is controversy about combining augmentation with lifting, and some surgeons never do this, some always, most decide case by case. 

Among the latter group most would not do an anchor pattern lift combined with a large implant, most would do a modest size implant and a vertical lift. 

If you are rather large busted, you might think about a lift alone, and you may find the outcome to be such that you don't need implants. 

All the best. 

staging procedures is not uncommon inplastic surgery. the second procedure may sometimes become unnecessary or unwanted with the passage of time

Hello and thanks for your question.

Single stage and two stage breast lift and augmentation should not look any different. The objective and the end results are the same wih either procedure.  It is usually a surgeon preference to perform one procedure over the other.  A two stage procedure is preferred if the surgeon believes there is a higher risk of a nipple areola complex complication. The two stage procedure is probably less risky for the patient in terms of the nipple areola complex however the main disadvantage is that it takes two procedures and hence, double the recovery time.

Good Luck with the planned surgery.

Stephen Salerno

A mastopexy augmentation is an operation that can be done in one or two stages. A one stage approach has a fairly high revision rate because in general you are doing two things that work against each other.  Adding more weight and volume by expanding the chest, and also reducing the skin envelope around it while lifting the nipple-areola complex. I usually do them in one stage.

These terms do not define a specific operation. They do not define a result. They cannot determine what look you end up with. They are merely a catagorization of surgeries based on if the augmentation and mastopexy are done at the same time or in two separate surgeries. Your result with determine if one  stage or two stages is more or less appropriate. Some surgeon never do these procedure simultaneously and some will prefer to do them together if same. Most decisions should be custoized to the  individual patient. The decision to do one or two stages is a result of a collaboration with your surgeon based on multiple factors including required elements of the augmentation (eg. size and style and position of implant) and mastopexy (eg. location and length of incision, method of carrying the nipple on a pedicle, degree of sagging present), risks to healing, predominance of need for augmentation vs. need for lift, risks of anesthesia in one longer vs. two shorter procedures, cost concerns, etc.

Robin T. W. Yuan, M.D.