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 55

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
4.5 out of 5 stars 48 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.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

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.

Christopher K. Patronella, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 44 reviews

Absolutely size matters!

If you think about it, a mastopexy is not just lifting the breast, it's tightening it also. Implants expand or increase the breast volume. So those two things are sort of conflicting objectives- tightening and expanding at the same time. Because of the skin that is removed to facilitate upward placement of the nipple, generally large implants can't be used at the time of the lift. It's unsafe, and usually the implant ends up being positioned too high. So if a patient wants a large implant it is definitely better to do the procedure in two stages.

Elizabeth A. Kinsley, MD
Covington Plastic Surgeon
4.6 out of 5 stars 46 reviews

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
4.9 out of 5 stars 55 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.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 34 reviews

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 178 reviews

Can a breast lift be done at the same time of breast augmentation?

Thank you for your question. In my opinion, these two procedures can be combined and done safely in the right patient (Non smoker, no medical co-morbidities, healthy, small size implant, mild ptosis). I would trust your surgeon's recommendation as physical exam is very important to determine if you are a candidate or not.

I hope this helps. Best wishes! (Dr. Salameh, Plastic Surgeon, Bowling Green, KY)

Bernard S. Salameh, MD
Bowling Green Physician
5.0 out of 5 stars 19 reviews

Breast lift and implants

implants can often be combined with a lift at the same operation. There are instances where it is better to do this in 2 stages. For example, if the nipple are extremely saggy or ptotic, it might be better to do it in 2 stages. It really depends on your anatomy. It is hard to comment specifically on your case without pictures or performing an exam. 

Samuel Maurice, MD
Des Moines Plastic Surgeon
5.0 out of 5 stars 3 reviews

Staged approach to Breast lift with implant surgery

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

Ellis Choy, FRACS(Plast)
Sydney Plastic Surgeon
5.0 out of 5 stars 88 reviews

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.