Mastopexy and Augmentation at the Same Time?

I need a mastopexy only around the areola and want to go to a full D cup (350cc). I am currently a 34 C. Since I no longer need an inflammatory incision and can be placed thru my areola he did say that I could go for saline since I have enough tissue to make the implant feel natural but since I am getting incision for my mastopexy, I could fit a silicone implant in the incision, he also suggested to make my areola's smaller. Help? Saline or silicone, areola smaller as well....will look nice?

Doctor Answers 11

Mastopexy and augmentation

About half of my patients get “staged” augmentation mastopexy (where the procedures are performed separately). The benefits of this are the following:

  • Since you can see the results of the first procedure (the lift), you can adjust the second procedure to complement results.
  • A lower rate of revision.
  • Surgical techniques can be selected to better achieve desired improvement.
  • A lower complication rate.
You can always get a second opinion from another surgeon as well, pending a physical examination.

Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Breast Enhancement Surgery

Lots of moving parts in this operation so its essential that you and your surgeon really understand your goals. The type of implant is not as important as the size of the implant and the plane in which you put it! GOOD LUCK

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

Can lifts and augmentations be performed together?

A doughnut mastopexy is very effective  in keeping the areola smaller even as the breaqst is made larger through an augmentation.  The technique will allow you to insert the implants either to a submammary or subpectoral position, depending what you and your Plastic Surgeon may recommend.  Silicone implants can always be introduced through this surgical technique, but if you prefer saline implants this will always be possible as well.  Lifts can be performed at the same time that the augmentation, thus giving even better results when indicated.


Good luck to you.


Frank Rieger M.D.  Tampa Plastic Surgeon

With Nipple

Dear Missy,

 Once you have decide that you would like a smaller areola and only need a small amount of actual "lifting" (or relocating of the nipple/ areola) then this option is quite good. The nipple or periarolar lift however, can have a flattening  effect since the skin tightened around a reduced nipple areolar  area. I therefore often us a higher profile implant to counter this effect and use a permanent stitch around the areola to prevent it from stretching it out in future. An excellent  long term result can thus be obtained as long as the implant size chosen is reasonable and your skin has good elasticity remaining.

As far as the saline/silicone is a matter of feel. You have to have significant amount of tissue fr the saline implants to feel as natural as silicone implants but they should look pretty much the same.

Manuel M. Pena, MD
Naples Plastic Surgeon
3.4 out of 5 stars 5 reviews

Lift and aug question

Hi Missy,


Thank you for the post. You will find this question has a lot of different opinions here. I do not like the around the nipple lift. it can only lift the nipple a small degree and is prone to stretching and enlarging of the areola. 


Second, I do not recommend the nipple incision for implant placement ; saline or silicone. The difference in capsular contracture risk is significant in my experience. 


pics would be helpful. Ask your PS to show you pics of what he/she is proposing. That would be most helpful. 
Best to you. 



Bennett Yang, MD
Rockville Plastic Surgeon
4.8 out of 5 stars 21 reviews

Simultaneous Augmentation and Mastopexy

Should not be a problem.

  • If a donut periareolar excision incision is indicated, this is the favored approach to placement of the implants as well.
  • All periareolar approaches to augmentation carry a slightly higher risk of bacterial contamination of the implants an future capsular contracture.
  • If a saline implant is used, there must be enough breast tissue to cover the implant or else it should be put under the muscle.
  • Most sizes of silicone implants can be placed through a periareolar incision if the areola is large enough, (350cc - no problem).
  • Donut excisions are done to both remove excess breast skin and reduce the diameter of the areola.

Martin O`Toole, MD, FACS
Los Angeles Plastic Surgeon
4.7 out of 5 stars 28 reviews

Mastopexy and augmentation

If you need a small areola lift, then I would probably say that is the way to go.  Silicone or saline is really up to you. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Mastopexy and augmentation at the same time

Can breast augmentation and mastopexy (lift) be done at the same time? The answer is: it depends. If there is minimal droop, then sometimes the implant will create a lift on it's own. If there is moderate droop (i.e. nipple at or below the breast fold), then there are at least two types of lift that can be done: 1. crescent lift which removes a crescent amount of tissue above the areola and then lifts it up to a higher location, or 2. "donut" lift which removes a donut shape amount of skin all the way around the areola, and then tightens around it. The donut lift can also reduce the size of the areola if needed.


If the droop is severe, then usually the augmentation and lift should be done on separate occasions separated by about 3 months to prevent too much pressure on the skin, leading to wounds opening up or skin dying.

James Motlagh, MD
Tyler Plastic Surgeon
4.5 out of 5 stars 36 reviews

Mastopexy and augmentation simultaneously

A periareolar lift can be done with big implants, but as with Dr. Gottlieb, I prefer to use the crease incision so as to not cut through the breast and also because it is being shown to have less capsular contracture formation. The PA lift is then just a skin takeout.  Gels feel better thn salines to most patients but you cna do saline if you have enough tissue to cover up the fluidity.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast Augmentation/Lifting at Same Time?

Thank you for the question;  as you can imagine, without direct examination or photos it is not possible to give you precise advice. However, some general thoughts may be helpful to you.

Whether the breast lift and augmentation should be done the same time  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 increased 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 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.

Ultimately, I think you will be best off selecting the plastic surgeon who you feel will most likely be able to achieve the results you are looking for and follow his/her recommendations.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,503 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.