Which surgery should be done first in a 2 stage surgery for lift and implant exchange going from over to under the muscle?

I currently have 350cc mod. over the muscle saline implants, making me a 32DD. I have mild contracture to left breast and bilateral sagging which require a lift. In 2 surgeries per DR recommendation, am planning to remove scar tissue, change to HP silicone, and go under the muscle (one surgery) and a lift (one surgery). I'd like to maintain same size. Is there recommendation as to which surgery to do first or does it matter? And should I consider slightly bigger implant to maintain same size? Thank you

Doctor Answers 16

Staged surgery

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This surgery you describe above is a common surgery that I perform at the same time.  I am not sure if there is a specific reason why your surgeon recommends performing it in stages, but in general this can be one surgery with one recover (which costs you less money also).  Best of luck to you!

Orange County Plastic Surgeon
4.7 out of 5 stars 52 reviews

Re-augmentation mastopexy can be done at the same time

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if you're accepting of the imperfections that may arise from the combined procedure as they oppose each other (one tightening the envelope and one trying to stretch it out) so ask if you want only one recovery.  Otherwise you should always have the explant-mastopexy first as you may find you don't need the implants after all.  If you're being charged for simply removing the implant, you can find better prices elsewhere.  If you're having capsule removed, then expect fees for that.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Do I need to do an uplift and breast implant exchange in two surgeries?

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Both of the surgeries-uplift and implant exchange can be done together which will save you money as well as recovery time! I sit down with my patients and listen to what they want to achieve and then formulate a plan.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Implant Replacement First

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The first procedure that should be done is to move the implants from over the muscle to under. Doing this procedure first will allow your body to reestablish blood flow from your chest to your breast tissue where the implant used to sit. This will significantly decrease the chances of loosing skin due to poor blood flow when you have the second procedure to lift the breast. 

Allen M. Doezie, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 57 reviews

Should you do a Lift or Implant first?

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There is no golden rule.  It will depend on how much breast tissue you have, how much sagginess and how bad your capsular contracture is.  If your breasts are very heavy and saggy, I would probably do your Lift first knowing gravity will cause them to settle into a lower position.  That way I could be determine where to position the implants under your breasts.  An examining PS would know best how to approach your particular problem.

Christopher Costanzo, MD
Thousand Oaks Plastic Surgeon
5.0 out of 5 stars 40 reviews

Breast augmentation revision with lift and implant exchange

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We perform breast augmentation revisions weekly to remove and replace the implants from over to under the muscle and doing the lift simultaneosly; there is no need for extra expenses and two recoveries. Please see examples below.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 106 reviews

Lift and implant

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I think it is a good idea to perform your reconstruction in two stages.  Most of the time, when this is performed, I prefer to do the lift first, wait until that is healed and after about three months place the implants.  I think it's safer that way and easier to just the implant size to be used.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Both surgeries at once

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Hello and thank you for your question.  The short answer to your question is that in most cases, I would your implant exchange, switching to submuscular position, and mastopexy all in one setting. There are certain maneuvers/techniques that need to be performed to achieve the optimal result, but what needs to be done is unique to each situation.  I highly recommend you seek consultation with a board certified plastic surgeon with expertise in revision breast surgery.  I hope this helps and best of luck to you!


Dr. Sean Kelishadi

Sean Kelishadi, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 32 reviews

Revision Augmentation Lift

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If you are to do it in two stages, you would do implant work first. You wouldn't want to do the lift with implants over the muscle, then place them under later. Your surgeon should be experienced enough to know that and not be giving you the choice, and that is concerning. If your surgeon isn't a ABPS certified/ASAPS member surgeon that specializes in revision breast surgery, you should consult with a few.  This is a surgery that is done in one stage all the time by those of us who are specialists. Best of luck!  Instagram: drgeraldminniti 

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

Which surgery should be done first in a 2 stage surgery for lift and implant exchange going from over to under the muscle?

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Unless a patient has thick and healthy breast tissue rather than thinned breast tissue, I separate capsulectomy from breast lift to avoid problems from poor circulation of the nipples. Consequently I would recommend capsulectomy and replacement of your current implants with similarly sized cohesive gel implants in a subpectoral pocket as a first stage followed by subsequent breast lift.  This would avoid a waiting period without implants which is preferred by most of my patients.  If you do have thick breast tissue with good circulation the risks to your nipples would be reduced and a one stage operation could be considered.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 33 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.