Is a one stage or two stage procedure better in my case? (Photos)

I have done my work and seen several Board Certified Plastic Surgeons.All of them have been delightful and knowledgable. 2 highly qualified docs want to do it in two stage procedures. Third says 1 stage is very good for me. Anatomical shaped texturized over the muscles. I love all the docs. Two have credentialed surgicenters which I like. Of course, I want a one stage but two say no. Would 1 stage be more painful?

Doctor Answers 7

Is a one stage or two stage procedure better in my case?

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Thank you for the question. As you likely know, receiving different opinions is par for the course in the field of plastic surgery. A single stage procedure will not necessarily be more painful than a straightforward breast augmentation procedure. As you also know, breast augmentation lifting surgery involves more complexity (and  risk of complications) than straight forward breast augmentation surgery.

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.
 I hope this, and the attached link, helps.  Best wishes for an outcome that you will be very pleased with.

Single stage lift with augmentation has many advantages

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Hi, I just added a link that might be helpful...

Hi whispers1110.  Thank you for sharing photos with your question.  I have had success with one stage lift & augmentation procedures.  Patients benefit from having one anesthetic, recovery (activity restrictions, after surgery discomfort), time off, and its slightly less expensive.  There is not a significant increase in discomfort with a one stage procedure.  Best wishes,

Possibility of Procedure in Stages

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I usually prefer to do surgery in one stage.  A number of plastic surgeons prefer two operations. The mastopexy followed by implant surgery.  These procedures  are usually staged at 2-3 months minimum to allow for swelling and healing to be at a reasonable point. My revision rate for one stage is less than 15%.   Two stages is not necessary for at least 85% of the patients when performed by and experienced Plastic Surgeon. If you feel that you would like the procedure completed in one stage, then it would  be best to discuss that with the surgeons in your consultations. Best of luck!

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

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Two stages is the way to go

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A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved. The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies. Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

1 stage breast lift with implants

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Thank you for your question.  Based on your photos, I would prefer to do a breast lift with implants in 1 stage.  With the 1 stage, the implants can fill your breasts, limiting the extent of the breast lift scar.  I would also prefer a submuscular dual plane placement of the implants as this reduces implant edge visibility and lowers the risk for capsular contracture.  A lot of these choices depend on surgeon comfort level as well.  Just be sure that you're with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

One or two stage

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Old school traditional/safe answer is two stages. Others would argue that although there is a high revision rate in doing an aug+pexy in a single stage, in the majority of patients it can be done in one procedure safely and a second surgery/recovery and General anesthetic wouldn't be needed.

One stage vs Two stage breast augmentation/mastopexy

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Thank you for your question.  This topic is somewhat controversial in the plastic surgery community.  The one-stage procedure can be a very safe and reasonable procedure in the right patient.  The concerns include maintaining a good blood supply to the breast tissue and skin, as well as not significantly increasing the risk of poor incision healing.  Based on your photos, you appear to be a very good candidate for the one-stage procedure because you do not have a significant amount of breast ptosis(droopiness).  Not to confuse you more, I would actually recommend the implant be placed beneath the muscle in a dual-plane which has been shown to decrease the risk of capsular contracture. The two stage technique will add additional cost and recovery time to achieve the same overall result.  Ultimately, you have to choose the surgeon with whom you are most comfortable.  Best wishes!

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