Do You Need Two Surgeries for Breast Lift and Augmentation?

The doctor told me that with a Breast lift and a Breast augmentation done in the same surgery/same day, I could only go to a B cup. Or I could have two surgeries, one to have the Breast lift and then the second one for the augmentation, where I could have any size implant put it.
The reason for this is so they don't have to worry about closing up tight skin around a big implant. I have never heard of this before. Does the size or your breast before the implant affect how big you can go?

Doctor Answers 50

Your surgeon's advice about a breast lift/augmentation is very wise!

Plastic surgeon's face a frustration that no other surgeon faces: responding to patient's wishes. No heart patient tells a cardiac surgeon how to operate, but plastic surgery patients are always pressuring their surgeon to do somethng that goes against their best judgment.

In general, lift and augmentations can be done at the same time. But there are trade-offs in doing it. No one can give you a steadfast rule about when it is and isn't wise to do them simultaneously versus staging them in two operations. Generally speaking, the greater the droop, the thinner the breast tissue, and the larger the implant, the safer, more accurate, and most consistent outcome is likely to be achieved doing a staged operation.

If your surgeon told you that, stick with his or her advice.

BUT - and this is a BIG but ---you should think carefully about your request for the "big implant" you wrote that you want. Stop and think aboiut it: though skin is removed with a lift, the skin that remains is the same poor quality skin that has already failed to support the weight of the breast. Adding more weight is therefore fundamentally illogical. We do it, and we can get good results, but the best long term results are achieved if the patient and surgeon are prudent about the implant size and WEIGHT. Remember, an implant has weight, not just volume!

If you ask around enough, you'll find another surgeon that tells you that he or she can do it in one stage. I assure you there is no secret technique that the person proposing a one-stage surgery possesses. It is a matter of how they weigh risk and how enthused they are to get you to schedule surgery with them on your terms.

Let me be clear: it can be done in one stage. But if a thoughtful surgeon has told you - based upon their assessment of your tissues, your implant size, as well as your expectations for the absolute perfection of the surgery - that you should do it in two stages, you would be wise to heed their advice.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 44 reviews

Simultaneous or staged augmentations and breast lifts

The degree of lift you need depends on how far down the nipple has gone and if it points down or forward.

If your nipple is above the lowest point of the crease below your breast and points forward, you can have a periareolar lift (just around the areola) and basically go with any size implant.

If your breast needs a full lift, however, the lift tightens you and the implant stretches you and these can cause complications if either is too much. So, there is a limit on how big you can go with a one stage procedure. If fact, while I usually do one stage augmentation mastopexies, just 5 minutes ago I told a patient she needed to stage the two because the size of the implant she would need was too big for the lift to handle. She'll wait 3-4 months between the two surgeries.

Combined Breast Lift and Breast Augmentation: One or Two Surgeries?

Combining breast augmentation and breast lifting can potentially make the procedure more difficult and result in less predictable results. In addition, wound healing complications can sometimes occur when the two procedures are combined. This is the reason many plastic surgeons perform the two procedures at different times, usually the breast lift first followed by breast augmentation a few months later. A careful exam assessing the quality of the skin, the size of the areola, the size of implant desired, and the amount of lift required can provide guidance as to whether a combined procedure can be accomplished safely with predictable results. In addition, a combined breast augmentation and breast lift can almost always be an option by using a delayed saline implant fill technique which I developed to reduce complications with this procedure.

Breast lift and augmentation in one operation?

If it is performed by a skilled and experienced surgeon, breast augmentation and lifting may be performed in the same operation.  Recently we published our experience with 1,192 of these procedures performed at the same time.

David Stoker, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 44 reviews

Breast Augmentaton and Breast Lift in One or Two Surgeries

It is true that doing a breast lift and breast augmentation in two settings is far safer from a blood supply standpoint. This has been well established. However, doing them together can be done safely.

Greater surgical skill is required to perform an augmentation mastopexy at on setting then at two settings. But it is possible and does occur tens of thousands of times per year. A skilled surgeon with experience can perform this surgery successfully in one setting.

Breast augmentation and lift, 1 or 2 surgeries

As many of my esteemed colleagues have noted, there is a lot of judgment in deciding whether the procedures should be done at the same time or different at two different settings.

Factors such as the health of the tissues, the thinness of the tissues, the difficulty of each procedure, whether they are revisional and what blood supply still exists after prior surgeries, the looseness of the tissues, the health of the patient as a whole, the patient's expectations, etc. all factor in. The big concern is that the nipple will lose blood supply and die, which can happen if too aggressive a surgery is performed. This is a complication that is usually avoidable by staging the surgeries, so the stakes in this decision are high.

Of course everybody wants the surgery in one setting. An experienced plastic surgeon can guide you through which choice is better.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 133 reviews

Implants and breast lift at same time

It is true that combining implant with lift can be challenging and some recommend staging it with two procedures. If you are wanting to go very large (>500 cc) then it is likely a good idea to stage it. If you are unsure about your doctor's recommendation, let him/her know and feel free to seek a second opinion. The best way to determine what you need is through a physical exam during a consultation. Best wishes!

Breast Lift and Breast Augmentation: One Operation or Two?

Some plastic surgeons never do an augmentation and a lift at the same time.  A breast lift operation (mastopexy) requires incisions into breast tissue.  This results in some small blood vessels being cut.  Some of those blood vessels supply blood to the nipple.  The bigger the breast is to begin with, and the lower the nipple, the deeper into the breast the incisions need to be made.  It is possible to cut through enough blood vessels that the blood supply to the nipple could be lost altogether.  That's bad!  If that were to happen the nipple would turn gray then black then need to be removed entirely.  That can happen just from a breast lift!  In addition to a breast lift, now a pocket has to be created behind the breast tissue and an implant placed.  That potentially compromises the circulation even more.  The bigger the implant, the more the circulation is compromised.

Breast surgery is an art.  Taking a smaller droopy breast and creating a beautiful masterpiece is not something everyone can do.  It is often possible to do an augmentation and mastopexy in one operation, but sometimes it is not wise.  It depends on a lot of factors, including how large the breasts are to begin with, how low the nipples are, how large the woman wants to be, her overall health, and her ability to comply with postoperative care.  I do have some restrictions on how large an implant I am willing to place in a woman when she is also going to have a mastopexy at the same time.  Usually I will design the lift but I actually place the implant in first, then adjust the design of the lift once the implant is in place.  For a woman who already has a fair amount of breast volume and kind of likes the way she looks in a bra, sometimes I'll recommend she undergo a lift without implants.   If she wants more fullness later she could then have implants placed.  I do not encounter this situation often, but it is a nice way to achieve shapely breasts safely in this group of women.

Kelly R. Kunkel, MD
Fort Worth Plastic Surgeon
4.8 out of 5 stars 20 reviews

One or Combined Procedures for Lift and Augmentation

I usually prefer to each in one stage. A number of plastic surgeons prefer two separate stages or surgeries; 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 or a combined surgery, is less than 15%. Two stages is not necessary for at least 85% of the patients when performed by and experienced Plastic Surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 93 reviews

One Vs Two Surgeries for Breast Lift and Augmentation

The size limitation for breast implants at the time of lift is mainly to prevent undue pressure on the closure incisions and involve the larger sizes but all depends on your exam. It is unusual for me to have to do 2 surgeries to match a patient's expectations.  Regarding the size you need to restore your pre pregnancy breast size: It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “B” cup to a "D” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link

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.