Can you have a breast reduction/lift and implant at same time? (photos)

Thank you for your question and photo. ,you most certainly can have both a #breastreduction and #implants at the same time. In my opinion, you would receive the best answers from a #BoardCertified #PlasticSurgeon who can do an in-person evaluation of you and can tell you what would be the best #recommendation for you. You would be wise to schedule #consultations with a couple of BCPS's, listen to their suggestions, ask to see before and after photos as well as testimonies from previous clients. I will attach a site where you can locate BCPS's in your area. Best wishes!

Based on your photos, a vertical breast lift with a small reduction of sagging breast tissue and a submusclar implant should deliver a nice cosmetic result. I've linked a photoset similar to your anatomy.

From the description photograph it sounds as though you are not a candidate for a breast reduction. A mastopexy will reshape the breast. Volume enhancement can be performed at the same time of the breast implant. Generally when a breast augmentation is done concurrently with a mastopexy the implant goes below the muscle.

Thank you for the question and photo. Based on your photo and request, you can have a short scar reduction/lift. Your breasts are low lying (even with your arms somewhat elevated), and a lift will not raise your breast above the current breast height or foot plate. You would do best with a submuscular augmentation/lollipop lift at the same time. Your breast size will not increase if the right implant is chosen, since the inferior pole sagging tissues will need to be removed. See a board certified plastic surgeon for an in person consultation/evaluation. Good luck.

All of this goes with
the caveat that none of us have examined you, but just a couple points to
consider:

1. These procedures are done at the same time
all the time and are safe to do together. Yes, there is a higher
"revision rate" if they are done at the same time, but most don't
require that revision surgery and do awesome. Revisions are done for many
reasons, sometimes in the pursuit of perfection and sometimes that pursuit is
encouraged by the surgeon when the patient is more than ecstatic about their
results. If you separate the surgeries, you are having two surgeries anyway-
automatically.

2. There are strategies to put results in your
favor. In my hands, those strategies include using a textured implant
under the muscle and lift that uses whatever incision is necessary to get you
the prettiest result. Do not skimp on an incision. We are trained
to create the prettiest scars possible and in time, these scars turn out
beautiful and worth the early stress.

Definitely seek consultation from a board
certified plastic surgeon that can deliver results and has a solid plan!
Best of luck and hope this helps.

-JGH

Thank you for the question and picture. Your picture demonstrate asymmetric breast ptosis and you will benefit from breast lifting surgery. Breast augmentation surgery may also be helpful if you wish to increase breast size and/or change breast shape further. You will not do well with breast augmentation surgery alone. 

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%. Patients should be aware of this higher revisionary rate; obviously, the need for additional surgery, time off work/life considerations, and additional expenses our “factors” that should be considered before undergoing the initial operation.
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.To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key. Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery.I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).

Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.

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.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. The attached link may also be helpful.

Hello and thanks for your pictureMastopexy alone, without implant, is a good
option for women who have some sagging or deflation, but who still have a
fairly significant amount of breast tissue that can be rearranged. When a woman
has a breast lift without implants, her breasts may end up looking slightly
smaller than before, even if no tissue is removed. This is because we are
rearranging the breast tissue into a smaller area and making the skin envelope
smaller. We can improve shape and projection with mastopexy alone, but we can’t
realistically offer significantly improved upper breast fullness without adding
an implant. In a breast like yours, you would still have a sloping upper breast if you had mastopexy alone. That's a nice natural look, but you would need to decide if it's what you're after.

For women who desire a lift but have very little breast tissue or would
like to have more fullness in the upper part of the breast, an implant is often
added.I would recommend that you arrange a consult with an experienced plastic surgeon. S/he can examine you and discuss your goals. I find it very helpful to look at lots of photos with my patients so I can understand what she likes, and she can understand what I can and can't do with each procedure.Best wishes-

It is possible to have a breast lift and implant placement at the same time, although the risks of healing issues does increase over doing the lift first and the implant later. This depends on your anatomy, the size and position of your areola and how far it needs to be elevated, how thick your tissue is, the size of implant you desire, etc. Aside from a simple lift (which is a skin operation), there can be problems with doing a full significant breast reduction (which requires a greater dissection of your breast tissue) at the same time as an augmentation in terms of interfering with the blood supply to the nipple, but a more minor reduction at the time of placing a small implant is less risky. A careful in-person examination with measurements would be helpful, and a thorough discussion of the options and the pros and cons of each.

Your thoughts are not unreasonable, but because you are going to need a lot of skin removed, I would recommend the lift/reduction be done and an augment 3 months later if you still feel it necessary (you may not).