Implants first and then a lift? (photos)

I know I need a lift. I want to get implants first and then 6 months later do the lift. This is for a multitude of reasons, financial, health and healing time wise etc. Are there any cons to doing it in this order? (yes I understand about double facility fees etc) My understanding is that you can have better results waiting to get a lift after implants. Is this a reasonable thing to do?

Doctor Answers 17

Lift first or implants first - both can work

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I will offer this either way and both work well. The "lift first" folks often are on the fence about the implant and want to see if they are happy with the lift alone. If so, they are done without implants or implant risks.

The "implant first" folks want the more painful recovery over first, want the fullness for the look in clothing immediately, are willing to look a bit odd (Snoopy nose deformity) for 4 months until the lift is done, and some even reason that their scars might be better by doing the stretching operation (implants) before doing the lift.

What is actually amazing is that there are several folks I've done who on paper for sure needed a lift but who were happy enough just with the implants that they skipped the lift entirely.

You can stage breast enhancement procedures.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Without having examined you, it’s hard to say for sure. However, I would likely recommend doing these two procedures at the same time. If you’re completely opposed to that option, my secondary recommendation would be to do the breast lift first and the breast implants later. Short of combining them into one procedure, this sequence is likely to yield a better result than doing the implants first and the lift later. Consult with a board-certified surgeon to further explore your options and the timing of your procedures.

Lee B. Daniel, MD
Eugene Plastic Surgeon

Implants and Lift Can Be Done Together

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Many plastic surgeons prefer two #separate stages or surgeries; the Breast Lift followed by Breast Augmentation surgery. These procedures are usually staged at 2-3 months minimum to allow for swelling and healing to be at a reasonable point.
However, I usually prefer to both lift and augmentation in #one surgery; if feasible.
My #revision rate for one stage or a combined surgery, is less than 15%. Two stages is not always necessary for at least 85% of the patients when performed by a #experienced Board Certified Plastic Surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Implants first and then a lift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello dear, thanks for your question and provided information as well... The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift with augmentation such as silicone implants, you will get very nice results, hugs!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 442 reviews

Getting the best result for your lift/augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is not a bad idea to separate your procedures and the order of which comes first is often surgeon preference. I must say, most ladies are keen to have both procedures combined for a single recovery and to reduce hospital costs but separating them gives greater opportunity for 'fine adjustments' in the second procedure.

My preference would be to perform the lift procedure first. This would allow me to achieve the correct shape of your breasts which can then be made larger with an implant. This lift itself gives some degree of 'auto augmentation', or the illusion of fuller breasts because the breast tissue is brought together and in a higher position on the chest wall. 

You will do well from this procedure and all the best with it!

Lift and Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I would do the lift first, and not the other way around.  Discuss your concerns with your surgeon.  Best wishes!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Best approach to breast augmentation/lifting surgery?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for the question and pictures. Overall I agree with your plan. The only difference is:  I would recommend breast lifting first, followed by breast augmentation at the second stage.  Some general thoughts regarding breast location/lifting surgery concerns may be helpful to you as you learn more:
Generally speaking, 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%.

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.
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. 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.
Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.

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. Best wishes.

Implants first and then a lift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question and photos.  There is no right or wrong approach to treatment of sagging breasts.  One can achieve a very good result with single stage or two stage approach.  However, one must realize that even a single stage or two stage approach may need some refinement revision or touch up due to skin laxity or stretch. It is important that one has a surgeon who is experienced in this treatment and listen to their reasons and preferences to achieve the outcome you desire. I would begin with with a face to face consult with a Board Certified Plastic Surgeon who has experience in these areas. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. Only with a hands on exam can this be determined. Once an exam and opinion is rendered then you can decide if surgery is right for you. In my practice I commonly do the augmentation at the same time as a lift. I would also caution a patient that not every patient can be done as a single stage procedure. Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 33 reviews

Do the lift first

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I would recommend (like many of my colleagues) to do the lift first.  I would rather get your lift done and have things tight when I place the implant.  I think you would look really weird if you do it the other way and would then worry about what if you need to put off the second surgery longer than expected?  Hope this helps.


Breast Lift First

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Aside from having a significantly suboptimal appearance after augmentation alone, performing the lift first allows the surgeon to make adjustments, if necessary, during the secondary augmentation. 

If there is concern that there will only be one surgery, you would be much better off lifted and smaller then bigger and abnormal looking.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 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.