Is it possible for me to have a breast lift with implants in one procedure? (Photos)

Question

I have been having online consultations with mutiple surgeons Who have advised I can have a breast uplift with implants. Only 1 surgeon has said the risk of nipple loss and complications is too high to have the procedure done in one sessions due to anatomy and sagging breasts and has recommended two sessions first Uplift then implants. Is this correct?

Emre Guvercin, MD, FEBOPRAS · Answer

Yes, it is possible to safely perform a breast lift and place implants in a single operation &mdash; and in your situation, the type of lift and global tissue management are what make this safe and effective.Why a Push-Up Lift matters hereBased on your anatomy and the degree of sagging, a Push-Up Lift (supportive mastopexy) is especially important because it:Repositions and reshapes your own breast tissue upwardCreates internal support, rather than relying on skin tension aloneReduces stress on the nipple–areola blood supplyAllows implants to be added without increasing nipple riskWhen a Push-Up Lift is used, the breast is structurally lifted from the inside, which is very different from simply “pulling skin tight.”Why one stage can be appropriateA single-stage approach can work when all contributing factors are addressed together, including:Push-Up breast lift (mastopexy) to correct true ptosisImplant placement in the same session to restore volume and upper-pole fullnessArm lift and J-torsoplasty (lateral chest/axillary excision) to remove the heavy pull from the sides that would otherwise drag the breast down againIf the axillary and lateral chest excess is not corrected, a breast lift alone often underperforms &mdash; which is why some surgeons prefer staging.Why some surgeons recommend two stagesTwo-stage plans are typically suggested when:Only the breasts are being addressed, not the surrounding laxityThere is concern about nipple circulation due to high skin tensionThe surgeon prefers a conservative, staged philosophyThis doesn’t mean one stage is unsafe &mdash; it means one stage must be done comprehensively.

Richard Baxter, MD · Answer

Most of the time it is reasonable to do implants and a lift together, recognizing that this combination has a higher risk or requiring re-operation. However, due to the very significant degree of sagging that I see in these pictures, there is some risk of nipple loss even without the implants so I would suggest staging them into 2 sessions. In your case, the safest approach is breast lift first, then implants later after you are healed.

Moises Salama, MD · Answer

Thanks for your question. Yes, it is possible to have a breast with implants done in one surgery. It all depends on your plastic surgeon's evaluation and plan. I recommend scheduling a consult for a proper evaluation. Be sure to always consult with a board certified plastic surgeon. Take care, Dr. Moises Salama, Board Certified Plastic Surgeon.

Liann Casey, MD · Answer

There are many ways to achieve similar results in the world of plastic surgery, and while some surgeons may perform a lift and augmentation regularly with your degree of ptosis, it is certainly a safer and more controlled method to perform a lift first, and then come back when healed to have an augmentation. So in short, neither surgeon is wrong. However, one may be more risk-averse than the others- and that's a great thing!

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your photos, you would certainly benefit from both. Significantly ptotic breasts are at greater risk for wound healing issues/NAC loss. With that in mind, I would recommend staging to allow for adequate healing without the added risk of implant infection/exposure. This does not necessarily mean combined procedures is the wrong approach but it does carry a greater risk.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Guray Yesiladali, MD, FEBOPRAS · Answer

Hello. Thank you for the clear description and photos. Whether a lift with implants is done in one session or staged is mainly about blood supply to the nipple and how much skin and nipple need to move. Without an in person exam any plan is provisional. The outline below can help frame next steps.
What is likely going on• Degree of ptosis sets how far the nipple must travel and how much skin needs tightening• Skin quality and tissue thickness determine how safely an implant can be added at the same time• Prior scars, smoking and very large implant goals raise risk for wound problems and nipple perfusion issues
Will time fix it• Time does not lift a breast that has true ptosis• Supportive bras change appearance while worn yet do not change position
Nonsurgical options while you decide• Professional bra fitting and tape for photos if you are delaying surgery• Skin care and weight stability help outcome quality. They do not replace lift mechanics
When a revision makes sense• If a single stage is chosen and the breast remains bottom heavy or the nipple sits low a planned secondary tightening can refine shape• If nipple perfusion looks marginal during surgery a surgeon may stage by design to protect safety
What a revision usually involves for this pattern• In a staged plan first stage reshapes and lifts with the chosen pedicle and sets the fold level. Second stage adds a measured implant once tissues are stable• In a single stage plan success depends on controlled pedicle choice, disciplined fold control, an implant that fits your base width and often internal support to hold the new shape• Plane choice can be dual plane or subfascial based on pinch thickness and animation risk. Very thin tissue may benefit from internal support materials• Limiting implant size when a large nipple move is required protects blood flow
Expectations and timeline• Single stage gives one recovery yet has higher odds of small touch ups later• Staged surgery takes longer in calendar time yet can lower wound and areolar ischemia risk in higher risk anatomy• Most patients are desk ready by two weeks after a lift with implants. Final settling takes months
Smart questions for your consultation• How many centimeters will my nipple move and which pedicle will you use• What is my skin and tissue thickness at the lower pole on pinch test• What implant volume range is safe with that pedicle in my case• Which plane do you recommend and how will you control the inframammary fold• Will you use internal support if tissue is thin• What are the specific reasons to stage in my anatomy and what would each stage include• How will you monitor nipple perfusion during and after surgery• What are your rates of return to theater for wound issues in single stage lifts with implants
If you would like a case specific view standardized photos and a brief history allow a tailored plan before any medical evaluation. Coordinators can help collect these details through a short complimentary conversation.
Wishing you a clear plan that prioritizes safety and delivers a shape that feels natural and stable.Güray Yeşiladalı, MD

Daniel Barrett, MD · Answer

Dear Thriving712418,

I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Generally a breast lift and augmentation can be done in one surgical setting.  Because of the degree of lifting that is necessary you are at higher risk of some complications including nipple and tissue loss and changes in sensation.  Depending on the implant choice, this risk could increase with augmentation.  Make sure you select a board certified plastic surgeon with whom you feel comfortable and confident for your procedure.

Mark T. Boschert, MD · Answer

It is possible that you have a lift and an augmentation at the same time. The short answer is there is a risk of injuring the nipple a real complex however that can happen with just a lift alone or with an implant. It really depends on how big of an implant you are choosing. I tend to do these together 99% of the time. Occasionally, if someone is picking a very large implant and has a tighter envelope I will divide it up. However, you have more than enough skin and if you are not picking a very big implant, then I think it is perfectly safe to do them together.
Best of luck! Dr Boschert Renaissance, Plastic Surgery

Is it possible for me to have a breast lift with implants in one procedure? (Photos)

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