My Doctor Wants To Split My Lift And Implants Into Two Surgeries, Is This Normal?

i had my consultation for an uplift with implants the other week but my surgeon has refused to do both ops at the same time due to the sag being too much was 27cm from collar to nipple is this correct procedure or is he just trying to get more money from me by asking me to come back for 2nd surgery thanks

Doctor Answers 24

1 or 2 Stage Breast Augmentation and Lifting?

Thank you 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 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 helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,503 reviews

Occasionally lifts and implants must be separated

Some plastic surgeons with not perform a full breast lift and breast augmentation at the same time as a general rule. Almost all surgeons will perform a small lift with implants.  There are situations where all surgeons would prefer to separate breast augmentation and a full breast lift. For me, this situation exists when a patient is in need of a full mastopexy and because the breasts will be so tight as a result of the lift, I feel that I can not put in an implant of adequate size to provide a satisfactory augmentation.  Almost any patient who needs a full lift and wants large implants (e.g. > 400cc's) will need to separate their procedures.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Breast Implant and Lift

The whole goal of BREAST ENHANCEMENT is to improve the appearance of the breast.  We have a lot of tools at our disposal to help accomplish that goal.  A consultation with a Board Certified Plastic Surgeon will be able to review the options and decide which approach is best for you.  If you have some ptosis (sagging) of the breast tissue here are your options:

  1. Breast lift alone (Mastopexy)
  2. Breast implants alone (Augmentation Mammaplasty)
  3. Breast implants with a lift (One procedure)
  4. Breast lift followed by breast implants in 2 separate procedures

The final decision is based on your health, anatomy, breast size, breast shape, tolerance for scars, how big you would like to be, experience of the surgeon, cost and recovery.  It appears from your question that you have quite a bit of ptosis and surgeon is worried about the safety of combining a lift with an implant.  The main concern is the blood supply to the nipple/areola.  If the blood supply is compromised then you may experience skin death or necrosis with loss of the nipple/areola.  That would be a disaster and require more surgery and rebuilding of the nipple/areola.  It is much better to be safe rather than sorry.

One of the advantages of staging the procedure with the lift first, is the ability to choose any size implant with the second procedure.  If the breast implant/lift procedure is performed at the same time, there is a limit on the size of the implant that can be placed.

All 4 of the above options are viable and a reputable plastic surgeon will steer you down the correct path, Good Luck!


David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

Breast Lift/Breast Augmentation At The Same Time-Maybe

Dear soldier's wife77,  Thank you for your question.  There are some plastic surgeons that always perform a breast lift and a breast augmentation separately and there are others that always perform these two procedures at the same time and then there those that sometimes perform them separately and at other times together.  Simply put, it comes down to what the plastic surgeon is comfortable with and what combination they feel will give their patient the best result.  By combining the two procedures, there are increased number of variables for the surgeon to address in order to obtain a stable, lasting aesthetic result.  If you think about it this way, with a lift you are tightening up breast tissues and skin that often were stretched by extra breast weight from childbearing, nursing, weight fluctuations, etc.  By adding an implant, you are trying to regain volume back to the breast but the implant also has weight which can add more stress on the breasts and increase the risk of re-stretching.  When a plastic surgeon performs a breast lift/augmentation combination, they are walking a line; tighten too much and you may not be able to use a big enough implant.  Put in too big an implant and you may increase the risk of the breasts rapidly stretching back out because of the extra weight.

Discuss your concerns with your plastic surgeon and if you are still uncomfortable, obtain a second opinion with a board-certified plastic surgeon.  Good Luck and thank you for what you and your family do for all of us.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 85 reviews

Breast lift with implants done at the same time a technical choice.

Breast lifts can be performed with or without implants, for different reasons and with completely varied outcomes.  It is very important to define what goals are desired, and to find a professional who is able and willing to reach those goals.

Breast lift can be performed in association with implants on the basis of very specific dimensional consideration that rely on:

  1. Breast size
  2. Tissue density
  3. Medical history

Consulting with different physicians and reviewing their outcomes as compared to the goals desired will clarify the problem.  Different Surgeons will have variable outcomes and combined procedures are always more technically demanding (and carry higher risks) than single procedures.

Mario Diana, MD
Plano Plastic Surgeon
4.5 out of 5 stars 28 reviews

Separating a Breast Augmentation and a Breast Lift into 2 surgeries

There is much debate over whether it is best to peform a breast augmentation and a lift at the same time or to do them as stage procedures.   And while there is no consensus on this, here are the salient issues.  First of all, you need to understand that peforming a breast augmentation at the same time as a breast lift is like stepping on the gas and the brake at the same time - a breast augmenation stretches out the breast skin envelope, while a lift tightens the breast skin envelope.  The risk of doing this is that although it will likely look very good at the end of the procedure, it is nearly impossible to predict how the breasts will "settle out".  So in 10 months, there is an increased risk that they may sag and look like they need a secondary procedure.  That said, it is more predictable to separate the procedures.  However, separating the procedures guarantees two procedures, while combining them only increases the risk of needing a secondary procedure (but does not guarantee it).  This, along with the fact that most patients do not want to undergo 2 separate procedures, is why most surgeons will attempt to combine the two procedures into one operation.  I am one of these surgeons, but I warn all my breast lift/augmentaiton patients that they are at a high risk of needing a secondary procedure early after the surgery.

Gary D. Breslow, MD, FACS
Paramus Plastic Surgeon
5.0 out of 5 stars 44 reviews

Breast lift and implants at the same time

Thank you for the question.  Yes, often times the breast lift and the implants can be done at the same time. It makes the operation slightly more tricky but in skilled hands can get excellent results.

Without seeing a photo, it is difficult to answer you specifically. It depends on how large of an implant you choose, whether it's saline or silicone, and the amount of extra skin and sag that you have.

If you want it done at the same time, it is okay to seek a second opinion. You may also ask how many lifts with implants together your surgeon does each year and how long your surgeon has been in practice. It can sometimes take some years of experience to become facile at performing breast lift with implants at the same time.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 183 reviews

Staging of breast augmentation and lift?

Hello! Thank you for your question! These two procedures can and effectively and safely performed in one setting.  Staging the procedures to have them performed 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. However, 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.  For this reason, it would be wise to stage these procedures.

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.   I would discuss your concerns with your surgeon and see what your options are. Hope that this helps! Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Splitting the lift and implant surgery - can be best option

The augmentation/mastopexy in one procedure is desirable for most women because of reduced cost and going under anesthesia once.  The outcome is harder to predict for challenging cases - where there is a heavy degree of breast sag (ptosis) or when the degree of desired augmentation is high.  Staging the lift and breast augmentation surgery is a very safe approach to getting the best aesthetic result.  I would make sure that you feel comfortable with your surgeons assessment, and also seek another opinion if you are unsure.  Good luck.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 38 reviews

Breast augmentation and Breast lift can be performed safely together


This was a hot topic about 7-10 years ago as plastic surgeons debated about the safety of combining the two procedures.  The evidence over the last few years has decidedly put the debate to rest as multiple publications have shown that combining breast augmentation and breast lift is safe and effective.  With that said, every plastic surgeon has his/her own preferences and every patient has different requirements.  If your plastic surgeon does all of the surgeries separate than that is their preference.  If they say that they do some together and some separate they will be able to tell you why you would benefit from doing the two procedures separate.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 166 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.