Must a Breast Lift and Implant Surgery Be Done in Two Operations?

I'm a 32 year old mom with D cup breasts who has lost breast tissue after the birth of my son. I want to have a breast lift along with implants to bring my cup size to an E. I went to my doctor this week and he informed me that A) I don't need implants and B) If I elect to have a breast lift, it will be impossible to do the implant surgery at the same time. Should I get a second opinion? I have been saving for this surgery for some time, but I can't afford the cost of both surgeries.

Doctor Answers 5

Breast Augmentation/Lifting: To Stage or Not to Stage?

Thanks for the question.
This is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately and there are good plastic surgeons who can produce excellent outcomes in a single stage.

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 increase with breast augmentation / mastopexy surgery done at the same time.

In my opinion, the decision  to do the operation in a single or two  staged fashion becomes a judgment call made by a surgeon after direct examination of the patient.  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 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  in 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.

I hope this, and the attached link, helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Breast Lift and Implant Surgery

Dear Alex, you are asking an excellent question. My best advice to you is to go get a second opinion by a board certified plastic and reconstructive surgeon in your area who will be able to examine your breast and give you a better idea of what can or cannot be done in one or two operations. A second opinion never hurts, I would reccommend it. I wish you the best!

James C. Pietraszek, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 14 reviews

Must a Breast Lift and Implant Surgery Be Done in Two Operations?

This is an area of controversy. Some surgeons will not to a lift and enlargement at the same setting. Some do frequently. Many do so under certain conditions. 

Without an exam, or at least photos it is hard to offer much in the way of advice. I would suggest in this situation a second opinion.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Breast lifts with implants

If you are already a size D breast, your surgeon may be making a value decision that you should not be bigger.  You should know that to a plastic surgeon your breast is essentially the envelope which is the skin and nipple and areola which is filled then with content. The content is ductal tissue and fat and in the implanted patient is also on implant.  When you add to content at the same time that you shrink the envelope, complications can develop.  This is one of the highest areas of liability in plastic surgery.  For that reason some surgeons will not do this operation together.  They would prefer to error on the side of safety.  In general when an implant is placed, the priority is given to the safety and security of the implant.  We avoid tightening the skin too tight so that the wound does not breakdown and the implant becomes exposed.  That problem results in significant dissatisfaction and lawsuits.  In my practice, I will do the operation together but always with a plan to do a second stage of the lift in the office in 6 months later where a little bit more skin can be removed.  In this situation a base hit is always better than swinging for the fences!

David Janssen, MD, FACS
Oshkosh Plastic Surgeon
4.9 out of 5 stars 17 reviews

Breast lift and implant surgery in 2 stages?

Without the having the benefit of a face to face consultation, it is impossible to agree or disagree with your surgeon's recommendation. It's always a good idea to obtain a second opinion. Your next consultant may agree or disagree with your first consultant. The more opinions you have, the better off you'll be in making an informed decision. It's important to find someone who has your best interests in mind to perform your surgery in the safest way to achieve your goals. Thank you for your question. Best wishes.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 164 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.