Why won't my doctor do a breast lift with implants at the same time? Will a lift alone do what I want? (photos)

Question

I am 22 with a full 34c cup. I went for my consult yesterday and I knew I would need a lift because my breasts are so saggy. I wanted a lift with implants because I want perky round fake looking breasts. I am ok with my size but I wouldn't mind being a D or DD. My Dr said he won't do them at the same time. I was devastated (more money and more down time and it will be longer before I have the body I want). Why won't he do it? And do you think just a lift will give me the perky round look I want?

Ary Krau, MD, FACS · Answer

Breast lift alone will not give you that round perky look you describe.  Implants would be required to achieve upper pole fullness and better cleavage.  This combination procedure requires more skill than either the lift or augmentation.  I suggest that you do a fair amount of research to find a plastic surgeon that is well versed in this combination procedure that could be done in one stage.Ary Krau MD FACS

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your photos.  Many Plastic Surgeons would consider doing the augmentation and lift at the same time.  There are more variables, and some additional risks.  This is why some Plastic Surgeons are more conservative and will do this operation in two procedures.  Others will do it in one, and get good results.Please seek out a couple of Board Certified Plastic Surgeons.  Certified by the American Board of Plastic Surgery.  On line look for ASPS and/or ASAPS members.  Discuss with them your goals.  They will go over your medical history, and do a proper exam.  At that point you will discuss what can be done.  Remember to have reasonable expectations.  The surgeon has your tissue to work with.  Together you and the Board Certified Plastic Surgeon will come up with a reasonable plan.

Aldo Guerra, MD · Answer

Hello newbbbss. Thanks for your question. A single stage or two stage approach is reasonable. In your case, your PS might think a single stage is too risky. Ask him/her to clarify his rationale. Best, Dr. ALDO.

Matthew Schulman, MD · Answer

A combined breast lift and breast implant surgery can be tricky but there are many of us who are experienced with this and comfortable doing it at the same time. Some docs are more comfortable doing it in 2 separate surgeries, but as you know, this commits you 100% to a second surgery. When combined in one operation, the results can be great, but there may also be about a 10-20% chance of needed a small touch-up or revision. It may be best to get another opinion from a surgeon experienced in a combined breast lift and implant surgery.

Matthew H. Steele, MD · Answer

Thank you for your question and photos. Some doctors will not combine these procedures together.  Based on your stated goals, I think you would need a lift and implant together.  Combining these operations does increase the revision rate and difficulty, but can be done quite safely.  I will sometimes stage them and perform a lift first in someone who has very significant sagging with a long distance from the sternal notch to the nipple, in some weight loss patients for the very same reason, and in some patients who have had a previous lift/reduction.  Without an in-person exam, it is hard to say with certainty, but based on what I see in your photos, I think you would do well with a combined procedure.  I would recommend that you get a few more opinions.  Good luck.

Steven Wallach, MD · Answer

Some surgeons will not do a lift and augmentation together for concerns of tissue, nipple or skin viability.   Best to get a few opinions.

Kenneth R. Francis, MD, FACS · Answer

Dear Newbbbss,If you asked 100 plastic surgeons what is the most difficult cosmetic plastic surgery procedure that you perform, probably 80 would reply breast augmentation and lift at the same time.  It is associated with a relatively high rate of revision so some surgeons prefer to perform the procedures in a staged fashion.  Good luck!

Bruce Hermann, MD · Answer

Hello!Some surgeons won't do a lift and implants together. To be fair, the risks do increase slightly if the procedures are done together. However, many (or even most) surgeons will do the procedures together to achieve excellent results with minimal risks. You do have quite a lot of breast tissue, so a lift alone would give you a very nice breast shape. I would even guess that once the lift was done and all your breast tissue was compacted up where it belongs, that you might even be in the D range, but hard to say from pictures alone without an exam.The bottom line is that it is very safe to do a lift and implants together. I do it all the time with excellent results and a complication rate so low I can't remember the last time someone had an issue. If you want both procedures and you want them at the same time and your current surgeon is unwilling to do it... find another surgeon. Hope this helps. B Hermann MD

Ashok Govila, FRCS, MCh, MS - Account Suspended · Answer

Hi newbbbssMany thanks for lovely pictures and the question.Many plastic surgeons are scared of wound infection if they combine the implants with a lift since there is a large suture line.You are in fact a perfect candiate to combine both surgeries in one.  Here in Dubai I do it routinely.

Kemil Issa, MD - Account Suspended · Answer

Hello thanks for your question, in my opinion breast lift with implants can improve the appearance of your breasts; some breast tissue could be removed to give to your breasts a perkier look. Some PS prefer to do this procedures in two times, but very good results can be achieved in one procedure too. Regards

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