Do You Need Two Surgeries for Breast Lift and Augmentation?

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.

Performing both a lift and augmentation at the same time is difficult and requires an experienced surgeon. The bigger the implant you choose, the less lift you will need. If you decide to go very large, you may not need a lift at all. I always do the augmentation first to get the size and volume you desire and selected pre-op, then I elevate the head of the OR table (during the surgery) to see how much of a lift you need. It may be a simple "half moon" scar above the areola or the full anchor scar for a mayor lift. After 30+ years I can fairly accurately predict how much of a lift you will need for the implant size you chose, so you have a good idea of the scar to expect.

Hi Ann, Thank you for your question. It is not very often that we find patients that are a good candidate to receive a breast lift and augmentation as a single procedure. When you think about the basics of each procedure, they are slightly contradictory of each other. Depending on the degree of ptosis and the size of the implant, your surgeon may run into significant limitations when performing these two procedures at the same time, taking the necessary amount of skin to achieve a satisfactory result can't always be done in conjunction with a breast augmentation due to the risk of suffocating the nipple and potential tissue death. The weight of the implant pressing against freshly dissected breast tissue and incisions can also pose a threat to obtaining a satisfactory result. It is likely that I would recommend you stage these two procedures in order to obtain the most aesthetically pleasing result. Before making a decision, please consult with a board certified plastic surgeon. Best of luck to you!

Thank you for your question!  When a breast lift is performed, it is common for the surgeon to remove skin while preserving breast tissue to keep fullness.  So in essence, there are tighter quarters with the same amount of breast tissue.  When performing an augmentation in addition to a lift, the breast implant may make the closure too tight and can place undo pressure on the blood supply to the nipple areolar complex.  One of two things could happen if the closure is too tight. (1) The nipple can loose its blood supply and cause loss of blood flow to the nipple which could cause loss of the nipple, and (2) the blood flow continues as usual, but the venous drainage from the nipple can become impinged and congestion follows that could also cause loss of the nipple.  It is extremely important to review your question with whomever you interview prior to your planned procedure.  There are some surgeons who only perform staged procedures, and others may be more amenable to performing this operation as a single stage.  I hope this helps

What you are saying is correct. Mastopexy can be done as either a single stage or two stages.  If the lift is less than two inches it can probably be done in one stage.  If you need to be lifted more than that I recommend two stages.  You will get a nicer result and the complication rate will be much less.

While breast augmentation lift surgery can be performed in an one stage manner, there are always limitations, tradeoffs and risks that one has to consider based on a multitude of factors including patient's tissue quality, preferences and surgeon's skills & experience.

It's difficult to advise without seeing any photos but in general doing a breast augmentation lift procedure in a two staged approach is a lot more controlled, reliable and "risk less" depending on the degree of upsize that you desire as well as the magnitude of tightening and lifting that is necessary to achieve the optimal surgical outcome that is right for you.

Always remember breast augmentation lift is a much more complex procedure to get right, whether performed in one or two staged approach. It has a significantly higher revision rate compared to either breast augmentation or breast lift alone. It's important to bear in mind there are competing factors that the surgeon is trying to negotiate, ie. trying to upsize your breasts with reasonable sized implants while tightening your breast skin envelope at the same time before determining the degree of lift that is suitable for your breast & nipple areolar proportions and dimensions. Achieving the right balance between all these factors but at the same time the right tension to acquire the ideal "look" & "feel" that you desire requires a lot of careful planning and consideration from your surgeon. 

My advise would be to adhere to your surgeon's recommendation provided you understand the reasons behind it, or else it may not be a bad idea to seek a second opinion from another fully qualified specialist plastic surgeon for further advice before making your final decision.

Hope that helps.

Best wishes

Ellis Choy

The top teaching surgeons around the country and world have validated the safety of a single surgery augmentation mastopexy.  Having performed many hundreds of breast lifts and augments in one procedure, I have tracked the results as part of the training and teaching I provide for this procedure. I am continually shocked that so many surgeons believe this has to be done in two procedures. It may occasionally be a better choice for some patients but for the vast majority of patients it is significantly more expensive and bears the risk of a second surgery and anesthesia.

This is a common question and every doctor has their own preference regarding when to perform a single stage augmentation/lift or separating the procedure into two surgeries. A two stage procedure decrease of the risks of having a wound healing problem and decreases the revision rate. In my practice I separate the procedure into two stages for patients who desire a larger implant, or who require significant lifting of the nipple. Separating the two procedures allows me to use a larger implant, because it eliminates issues caused by tightly closing the incisions around a large implant. Separating the breast lift and the breast augmentation decreases the chance of needing a revision procedure, particularly in someone who requires a lot of lifting of the nipple. If the nipple needs to move more than 6 cm, I separate the two procedures. If the implant is less than 300-350 cc, and the nipple is moving less than 6 cm, I perform a single stage augmentation/mastopexy.

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!

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.

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.