Will a Breast Lift and Augmentation Require Two Seperate Procedures? (photo)

I have (in my opinion) severe sagging breasts. My breast have been like this since puberty. I haven't had any children but I have loss a significant amount of weight which only made the sagging worse. In order to achieve perkiness and volume, will I need to have the breast lift done by itself or can the lift and augmentation be performed simultaneously?

Doctor Answers 10

Whether or not to stage an augmentation and breast lift.

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It is common to perform augmentations at the same time as breast lifts. However, in severe cases of breast ptosis, I will typically recommend performing the lift first and follow with the augmentation in a second operation after the breasts have healed. The reason is two-fold:

  • Many women are unsure of how "big" or "perky" they really wish to be until the breasts are in a better position.
  • The results are more predictable with a lower complication rate

Augmentation mastopexy as a combined procedure has the highest complication rate and revision rate of any cosmetic breast surgery. Staging reduces both the complication rate and the revision rate by simplifying the overall procedures. If you are happy with your breast size when in an appropriately fitting bra, then an implant is unlikely to be necessary.

Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Will a breast lift and augmentation require two separate procedures?

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Hello! Thank you for your question and photos! These two procedures can safely and effectively be performed in one setting, given you are healthy and without medical comorbidities to prevent such. Staging the procedures to have them done at various times will likely not have any cost benefit for you. When you combine procedures, there is often a discount that is provided by the surgeon for multiple procedures. Also, when having multiple procedures performed at the same time, you save on anesthesia and facility fees, which otherwise are paid for with each individual procedure. In addition, you may benefit by the single recovery time. Cost of these procedures will vary amongst plastic surgeons in addition to geographic location.

However, more important than the financial aspect, your plastic surgeon will have to determine for you if the viability of the breast as well as nipple-areolar complex may be placed at jeopardy if done at the same time. If for this reason, it would be wise to stage these procedures. Without an examination, it is difficult to tell you what to recommend.  But, in your photos, with the magnitude of lift that is required, staging the procedures may be a reasonable decision.

Certainly it is you decision as to whether you have your procedures performed in one or multiple stages, but your surgeon will give his/her recommendations. Consult with a plastic surgeon well-versed in breast surgery who will discuss and examine you, while assisting you to decide which procedure will be the best option for you. I would discuss your concerns with your surgeon and see what your options are - sometimes multiple consultations with board-certified plastic surgeons is helpful for you to decide. Hope that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Try the breast lift first!

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CJ: your photos appear to show a variant of "tubular" breasts, which are a large areolar complex, droopy skin envelope and narrow base.  Most PS agree that a simultaneous breast implant-lift is a hard op because there are many priorities which both the patient and surgeon hope to achieve: short scars, nipples on the same axis, equal breast volume, among others.  First, define your "ideal" breast,  (cup size, projection, how much upper pole fullness you would like) then consult with a BC/PS to agree on a plan. Remember that an implant-lift will also "age" or settle with time, just like unenhanced breasts do.  Choose well and speak your mind.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Breast lift and augmentation, separate or combined procedure

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From looking at your photos, you have extreme ptosis (sagging) but sufficient breast tissue to need only the uplift, according to how large you want to be. My suggestin is to go forward with the uplift and then evaluate the outcome. Remember that if you add more weight with an implant, you will probably get earlier sagging in the future. There is no muscle in a breast to hold it up, just breast tissue and fat.

Most patients that have an uplift with implants have them done at the same time, but the difference is your breast tissue volume and the extent of the sagging that makes the difference in the procedure needed for you.

You should always do the least that is required to achieve your goals. This means to eliminate the implants if possible. You will get recurrance of some of the sagging regardless of what is done. Keep the weight in your breast down as much as possible. You may not need an implant.

The procedure we do in my office is called an auto-augmentation (the word auto stands for autologous), and this uses the lower part of the breast to tuck under the remaining breast to maintain durability and projection as much as possible for as long as possible.

Will a Breast Lift and Augmentation Require Two Seperate Procedures? (photo)

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An Augmentation and lift procedure is the hardest operation I feel that we do as one operation. We are changing so many things at one time that it makes it hard to get perfect symmetry in one operation. Being that said I do them in one operation all the time, but in women with much less droop than you. When you have as much sagging as you do and the nipple will need to be moved a long way it would not be a bad idea to stage the operations. The goal of an augmentation and lift is to restore volume and rejuvenate the breasts into a much better anatomical position on your chest. Most women say, "I want them higher and I want them perky." From looking at your pictures you do have a lot of breast tissue so I would start with a lift first. I would stage your surgery. I do not feel that after a lift you will be totally happy because I thing that you will still lack upper pole volume which is what everyone wants. You will likely then will need an augmentation, and you will have a better result with better symmetry if you stage your operation.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Implants Not Necessary To Achieve Upper Pole Fitness

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Dear CJ,

You seem to have enough breast tissue to undergo the Ultimate Breast Lift without implants. The UBL reshapes your breasts internally and anchors them securely to maximise longevity. There is NO VERTICAL scar which inherently weakens the skin envelope and allows 'bottoming out'. With the UBL the skin envelope remains intact making it a structurally stronger lift. No need to have a double procedure.

Kind regards,

Dr. H 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Breast lift and augmentation 1 vs 2 stages?

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Different surgeons will have different answers to your question.  Given your severe sagging, I would suggest you proceed with a breast lift first.  If more volume is needed, then you can always come back for an implant later.   In my opinion, a combined augmentation and lift will limit the amount of lifting that can be done.  Even if you opt for a combined procedure, I believe you will need a secondary touch up to achieve the best results.  Hope this helps.

Dr. Basu

Houston, TX

Will a Breast Lift and Augmentation Require Two Seperate Procedures? (photo)

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You have large breasts with sufficient volume,So all you need is a breast lift

If you wanted even more volume , I would recommend an adjustable saline implant ,which will reduce the risk associated with combining a lift with augmentation.This will also enable you to have input into your final size

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Breast lift procedure

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I agree that in your case with a large amount of extra skin a staged approach would be best. I hope this helps.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Breast lift and augmentation

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Different surgeons have different opinions on whether or not a significant breast lift should be performed at the same time as an augmentation.  The most conservative answer is that the two procedures should be performed separately when a major lift is needed.

Your photographs show a significant amount of lift will be needed.  I would most likely recommend staging this procedure from your photos.  

Lifts and implants are basically opposite procedures.  A lift tightens the lift and repositions it and an augmentation stretches the tissue to make it larger.  This makes it difficult to combine two opposite procedures and get a great result.  The other problem is blood supply to the tissue in a lift and an implant at the same time decreases this significantly.

I perform lifts and implants together quite frequently on ladies that do not need a major lift.  However, when a lady has a very significant amount of ptosis (droopiness) to begin with I believe the procedure should be staged for safety, better scarring, and a better result.

It looks like you are local and I would be more than happy to meet with you in a complimentary consultation to educate you and discuss options if you would like.  Best of luck,   Evan Sorokin

Evan Sorokin, MD
Cherry Hill Plastic Surgeon
4.8 out of 5 stars 77 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.