BL/BA vs BL and BA separately?

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation. Many surgeons have different views on this.  In my practice, in almost every patient, I perform a breast lift with breast implants at the same time in a single procedure.  This can have very safe and reliable results when good technique is used.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for the good question.  
 Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, 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 increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.  
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate. The analogy I use in my practice is that of a thinned out balloon, being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.
 
 
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. 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 in 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. 
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well.  Be careful about utilizing cup size references when it comes to communication.  In my practice, the use of computer imaging and goal photographs is much more helpful. Working together you will come up with a good plan to achieve your goals.  
Best wishes. 

If you need both a breast aug and lift, I recommend doing them at the same time for many reasons. It is less expensive, there is one anesthesia and recovery time, and it is easier to determine the proper dimensions of the mastopexy needed with the implants in place.I have not done the two procedures separately in years when both are needed.Thank you for your question and good luck.