Breast Lift + Implant Later Vs Lift and Implant Together?

After weight gain/loss I now have 1 breast about a C? and one D/DD? both sagging. No children yet. Had 2 consultations, both reputable drs, first said under no circumstances to do lift & implant together because my skin is too thin and would scar and sag. He recommends 2 surgerys 1 year apart, 2nd said yes implant/lift could be done. I'd like to end with both breasts lifted around D/DD max. I've scheduled another consultation but can't get in for a month and am looking for some direction.

Doctor Answers 23

Lift and Implant together

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Although I have always performed breast lifts with implants in a single stage with very low revision rates over the past 25 years and I have not experienced more excessive scarring. Even if this did occur it could easily be taken care of as an office procedure later. I have no problems however with other plastic surgeons who feel the need to do this in two stages. It is becoming a trend to do breast lifts with implants in one stage however the important point is that surgeons should do what they do best. Usually their training determines what technique they will perform in the future.You should never "force" a surgeon to do a technique that they do not feel comfortable performing.
Make sure you pick a board certified plastic surgeon.

Breast Augmentation/Lifting One or Two Stage?

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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 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.

Breast Augmentation vs Breast Lift

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Patients who come to see that are dissatisfied with the appearance of their breasts and there is a bit of confusion as to which operation will improve their breast contour.  The question can really be answered by first identifying if the volume of the breast is satisfactory to the patient.  One simple way to determine this is to ask yourself this:  If you are in a well-supported bra, do you like the size of your breasts?  If you answer yes to this question, then it is unlikely that breast augmentation will be indicated for your particular situation. 


If the breasts have more a droopy appearance, the next step is to identify to what degree.  Then, we can determine which operation is best suited to correct the drooping.  We, as Plastic Surgeons, have methods of identifying the degree of drooping by how low the breast tissue and nipple have descended below the level of the inframammary fold.  The inframammary fold is the landmark of the chest at the very base of the breasts that affixes the lower part of the breast to the chest wall.  The specific lift operation to address this issue depends on the amount of drooping or how low the breast tissue and nipple have descended below that inframammary fold.  

Paul Fortes, MD
Houston Plastic Surgeon
4.1 out of 5 stars 17 reviews

Staged augmentation/mastopexy?

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Hello! Thank you for your question! These two procedures can effectively and safely be 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. Consult with a plastic surgeon well-versed in breast surgery who ill 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

Breast lift with augmentation - 1 or 2 stages?

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There is much controversy regarding breast lift with augmentation.  Some plastic surgeons never perform the 2 together, citiing too high of complications and revision rates.  It is true that breast augmentation and breast lift alone have much lower complication and reoperation rates than the combined procedure.  In a difficult case of thin skin and asymmetry, it is not unreasonable to stage the 2 procedures.  However, another way of looking at the problem is that if you do the procedures separately, you will have a second operation 100% of the time; whereas, if you do the combined procedure, you may have a second operation 25 - 30 % of the time.  Additionally, the second procedure would likely be a revision in retightening the skin, since it is already thin and minor revision mastopexy which is a lesser procedure than either breast augmentation or breast lift is alone.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast implant and mastopexy

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Surgeons will have differing opinions as to whether or not a breast augmentation should be performed at the time of mastopexy. Although there may be more chance of complications when these procedures are performed together, in many patients it can be done without inordinate extra risk. Issues such as significant size discrepancy and very thin and attenuated tissues such as with significant weight loss can create more problems. A beast lift with small reduction on the larger size would allow maximum skin tightening and breast symmetry. This could then be followed with an augmentation in six months using the same size implants which would afford the best symmetry with the least risks of perioperative complications. If symmetry is to be achieved in your case in a single operation, either different size implants need to be used or a breast reduction needs to be done on the larger side. Neither of these solutions are ideal. Although it is more inconvenient and  somewhat more costly, staged procedures are at times more prudent.

David A. Bottger, MD
Philadelphia Plastic Surgeon
4.9 out of 5 stars 59 reviews

Would you be happy with a C cup?

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You are caught in the controversy between those who are adamant about never combing these procedures and those who KNOW it can be done together (although risks for less than perfect results are higher). 

Since you've not had children yet and I assume would like someday to be able to have them, my suggesting is to simply have a Rubin Mastopexy where you will be made more even, perkier and theoretically should still have the ability to breast feed if and when that becomes an issue.  But you would have to be happy with a C cup which I would think would be okay for the majority of young ladies.  Don't forget that as you age and gain weight, you will often gain some weight in your chest too.  Finally, you avoid all the potential risks of implants but you will have to accept the scars that would come with such an extensive breast lift.

I hope you are able to find the solution that will achieve your goals. 

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast lift with implants

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Breast lift (mastopexy) surgery is often performed at the same time as placement of implants (augmentation) in appropriately selected patients. Since you have not had any children yet you may want to consider the possible benefits and risks of doing these procedures (together or separately) before childbearing as your breasts will change with pregnancy and breastfeeding. 

Olivia Hutchinson, MD
New York Plastic Surgeon

Breast lift with augmentation - 1 operation or 2?

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My general approach to relatively large asymmetric breasts with ptosis (drooping) is to perform a differential inferior breast reduction through a vertical approach and place submuscular implants to create superior fill and cleavage.

By placing the implants in a submuscular plane you are establishing a situation where they will not descend appreciably over time unlike a prosthesis placed subglandularly. The inferior pole reduction treats the asymmetry and also removes breast tissue from the area where you do not want it. I have found over the years that a single operation does the trick (even in the most difficult cases) whereas the costs of staging greatly outweigh any possible benefits. If any  re-operation is necessary after the combined procedure, it is usually not of a significant nature.

It is good that you are getting a third opinion and make sure they show you photos of how they handle a case similar to yours. Good luck!

Breast lift and augment together

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it sounds like you have asymetry and want to go quite large. i would suggest two operations when a large implant is involved.  i would do the mastopexy first and equalize the breasts. then i would do the augmentation 6 months later, when i could also touch up the mastopexy. i think this is the safest way to proceed.  i believe the secondary operation rate for all comers for an augment-mastopexy is about 40%

Jonathan Saunders, MD
Newark Plastic Surgeon

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.