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.