In a Staged Breast Augmentation/lift, Which One is Best to Do First?

I am somewhat confused whether the breast aug or lift should be done first. I have heard conflicting opinions from doctors. I understand a lift first would be good because the patient may be satisified with that alone. However, if the lift is done then the aug, wouldn't that cause the scars to stretch? I am certain I want to have both done and not sure which would be optimal for me. I am looking to go from a C to DD. Thanks to all, I appreciate your answers! :)

Doctor Answers 29

In s atged breast augmentation/lift, which one is best to do first?

Hello! Thank you for your question! These two procedures can safely and effectively be performed in one setting. Staging the procedures to have them done at various times will likely not have any cost benefit for you. When you combine procedures, there is often a discount that is provided by the surgeon for multiple procedures. Also, when having multiple procedures performed at the same time, you save on anesthesia and facility fees, which otherwise are paid for with each individual procedure. In addition, you may benefit by the single recovery time.

However, more importantly than the financial aspect, your plastic surgeon will have to determine for you if the viability of the breast as well as nipple-areolar complex may be placed at jeopardy if done at the same time. If for this reason, it would be wise to stage these procedures.  The decision of which to do first will likely be surgeon preference.  Not every case is the same and the planning is changed for each individual.  Often times, I prefer to place the implant and then lift the breast atop the augmented breast, but, it is on a case-by-case basis.

Certainly it is you decision as to whether you have your procedures performed in one or multiple stages, but your surgeon will give his/her recommendations. Consult with a plastic surgeon well-versed in breast surgery who ill discuss and examine you, while assisting you to decide which procedure will be the best option for you. I would discuss your concerns with your surgeon and see what your options are - sometimes multiple consultations with board-certified plastic surgeons is helpful for you to decide. Hope that this helps! Best wishes for a wonderful result!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast lift first then breast implant in a staged mastopexy augmentation. No debate

Not everyone is a candidate for a one time mastopexy augmentation, and it sounds like you are already on the large size and would like to larger. In this scenario, I would recommend a staged procedure with the lift or mastopexy part first and then the breast implant. This all depends on whether you need a lift at all, and I hope this has been already discussed with a plastic surgeon. The scarring is favorable with this technique as your mastopexy scars would have matured by the time the implant is placed.

There really should not be a debate about this as this would be the accepted procedure in a staged procedure. An immediate lift and implant is the opposite.

I hope this helps.

Dr. Trussler

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 45 reviews

Breast Lift versus Augmentation

There really is no standard answer of whether the breast lift or the breast augmentation should be done first. There actually is a third option which is do the breast lift and the augmentation at the same time. Basically, I would suggest talking to your surgeon and stage the procedure as they recommend. If you force your surgeon to do a procedure in an order that they do not normally do, then you really cannot be assured of a predictable outcome. Good luck with your procedure.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

In a Staged Breast Augmentation/lift, Which One is Best to Do First?

Thanks for the question. If  I plan to stage a breast augmentation/lifting procedure, I will generally do the breast lifting procedure first.
 Generally speaking, whether or not breast augmentation/lifting should be gone in a single  operation or staged fashion  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 increase 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 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 one stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
I hope this, and the attached link helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Staged vs. single session breast augmentatiion and breast lift

The decision making for this combination of procedures requires a great deal of experience.  Will the lift make the envelope too tight?  Is a lift even necessary?  What type of lift is necessary?

By examining the dimensions and shape of your breast, and comparing that with a personal database of thousands of patients, an experienced board certified plastic surgeon will give you a concrete answer.

You may wish to talk to several surgeons to see is a single plan comes out as dominant.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

What comes first: the lift or the implant?

My late father, also a Plastic Surgeon always staged the lift first and the implant, 6-9 months afterwards.  Choosing this interval, a lot of the scar maturation had already occured and so little additional stretching occured with implant placement.  Additionally, some women opted out of the second stage because they were content with the reshaping procedure alone.  "Beauty is in the eye of the beholder". 

While most of my patients understand the rationale for staging, they generally prefer a single procedure: aug-pexy, even if they accept that small revisions may be required. There are competing interests in an augmentation mastopexy: a) equal volume; b) nipples in line; c) short, good quality scars; d) longevity of the result.  When performing these two procedures together, I always start with the lift, first, so that the difficulty of the operation is overcome by making the breasts as symmetric as possible, before enhancing the volume.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Breast Lift and Breast Augmentation- which one first?

Hi there-

This will come down to surgeon preference.

In my practice, I almost always (because I completed an additional year of training in advanced breast surgery after my plastic surgery training) perform them together. 

I do know that less experienced surgeons do prefer to stage the procedures, and would agree that if unable to reliably and consistently produce excellent outcomes from a single stage procedure that staging is preferable.

If I were to recommend staging, I would suggest the lift be done first, and that you proceed with augmentation ONLY after you have achieved a beautiful breast shape with which you are very happy.

Doing so should not cause the lift scars to stretch, provided the procedures are timed appropriately.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Mastopexy-Augmentation - staging vs one-stage

This is a great question, and its been fun to read the other surgeon's responses.

The only thing I could add to the very cogent and informed opinions from the experienced surgeons on this forum is this: you may be delighted with the appearance of your breasts after a mastopexy.

Some patients are so happy with their lifted, rejuventated breasts after mastopexy that they decided the additional upper pole volume that an implant gives is not worth an additional procedure.

For this reason- if you decide to stage your procedures, it makes sense to do the pexy' first.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Single Staged Breast Augmentation and Breast Lift

A breast augmentation and breast lift can be performed at the same time in the right hands. It is a delicate balance but an experience board certified plastic surgeon can eliminate two recoveries or surgical procedures. It is also acceptable to perform the them in 2 different procedures and if in that case a breast lift is usually done first to allow the scars to heal without any tension.

Ankit Desai, MD
Jacksonville Plastic Surgeon
5.0 out of 5 stars 20 reviews

Key to breast lift and breast augmentation

The key to understanding breast lifts (mastopexy) and breast augmentation or a combination of the two is knowing what each do and do not do and to a lesser degree to know what the advantages and disadvantages of doing both together are.

A breast lift is properly only done to reposition the breast at a higher level. It can scale down the size of the areola around the nipple. It does not increase or decrease volume. It doesn't make a breast look perky or fill out the center or fill in the upper concavity of a breast. To properly reposition a breast requires incisions around the areola and from the areola down to the crease below the breast (but not in the crease). In my opinion it is not worth doing this unless the breast is too low to be filled out with an implant. In other words, the breast is low (saggy) enough to benefit from a lift, a more complex procedure than an augmentation.

Breasts that are too low (where the nipple is more than two centimeters below the inframammary crease level) cannot be augmented and reliably look normal. Therefore if a lift and an augmentation are considered, the lift has to be done first. The breast will look bigger because it will be higher on the chest and is then in the proper position to be augmented if the patient still feels she needs this.

Breast augmentation with implants is like putting a pillow behind the breast. It only provides volume and does not lift the breast but does give it forward projection and fill in as it does for the upper area above the nipple-areola. The scar tradeoff is minimal. If a breast is not too low and it is filled out properly with an implant it will look lifted but the minimum size increase is about a cup size. Therefore, if the breast is not too low and a cup size or more will be an acceptable size, then an implant alone is indicated. The breast can be lifted later on if it sags enough to need it.

The advantages to doing both at the same time (assuming the breast is too low and needs a lift and a minimum cup size increase will not be too big) is one operation and recovery instead of two and cost saving. The disadvantages are that two operations are being done on the same breast at the same time and they work against each other in terms of risks, scars, healing, and the predictability of the outcome. It is also very difficult to gauge the effects of the lift and volume increase at the same time. Secondary surgeries to adjust things are more common than either procedure alone.

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

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.