the issue you mention is the classic dilemma with breast lifts. Whether an implant should be done at the same time.Proponents claim it is cheaper and one operation. Those against state it has a high comlication rate and high revision rate negating the savings. They also state the compromise leads to many patients being unhappy. Common sense tells us the lift is a tightening operation and the implant an expanding operation. True, an implant sometimes leads to more fullness that a lift alone cannot accomplish.I feel the SERI mesh can help with the superior fullness. I also find a small implant is usually more of "rock in a sock" than what the patient is looking to achieve. The surgeon cannot put in a large implant at the same time as a lift and compromises with a small implant. But the dimensions of the small implant are too small and do not give the superior fullness the patient wants. The SERI mesh also seems to have less recurrence of droop and supports poor quality tissue better. It is silk and replaced by the patients own collagenI now usually recommend a two stage approach for better and safer results. Certainly in someone who already is a D cup might find that they are happy with the lift alone and not do the implant, avoiding the costs and potential complications of the implant. If they have excess tissue at the sides of the breast that also can be used to auto augment without the need for an implant. If the second stage is needed the patient can pick the implant they find perfect. I find some never do the implant and many choose a larger implant than would have fit anyway, making the extra cost worth the results. The stages are done at least 3 months apart but can be as long as desired.I would recommend another consultation. Usually someone who is a D cup and then picking a small implant is choosing a procedure that may not meet their expectations. Likewise an implant in poor tissue can lead over time to further droop and sag. I find the cohesive gel or gummy bear implants have the least risk of this recurrence.
