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 58

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

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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
4.6 out of 5 stars 49 reviews

Simultaneous or staged augmentations and breast lifts

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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?

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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.

Absolutely size matters!

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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 47 reviews

Breast Augmentaton and Breast Lift in One or Two Surgeries

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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

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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 195 reviews

Breast Lift/Augmentation is a complex procedure

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Your information is correct.  You are well advised to stage the procedure if this is recommended by an experienced surgeon.

The procedures are opposites in many ways- the lift is an anti-gravity procedure, and the augmentation is a gravity enhancing procedure.  It is a delicate balance when they are combined.  As far as when to stage or combine, this is based on the quality of your tissue, the amount of sag, the desired goal in size of implant, And the experience in this procedure by your chosen surgeon.

Best wishes,

Sergio Maggi, MD

Director- Austin Plastic Surgery Center

Breast lift

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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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 30 reviews

Two-stage surgery exists, but not without its drawbacks.

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It's possible to have a breast lift and an augmentation done on the same day, but what you were told is true - if you do so, you cannot max out on implant size. A breast lift is performed by removing some of the breast's skin and carefully stitching the edges together. Maxing out on size would mean the breast implant would significantly tighten your skin, pushing outwards. Put these two things together, and you could be setting yourself up for significant complications during your recovery period.

In the past, doctors would stage procedures not because they wanted to reach a larger size, but because they were not sure if doing both procedures in the same day would cause complications for the patient. 

Nowadays, we know that it's perfectly safe to do both procedures at once, therefore minimizing the cost and recovery time.

To answer your question directly, there are too many variables at play to determine both your final result and the size of implant you might be able to get later before actually performing the lift. It could be a much larger size, yes, but it could also wind up being even less than before if enough skin is removed. Therefore, I suggest going as big as you can while having both procedures done at the same time. If later it turns out you want to go bigger, you still can. 

If you want to have a two-stage procedure, you're already committing to having two different surgeries with no guarantees that you will be able to have larger implants afterwards.

I hope that answers your question. It’s great that you’re doing this research. I always say that the best patients are informed patients.

You might also want to research your options for breast implants. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?

A term that I use with my patients for the perfect implant is the “Pony Implant”.

So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.

Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.

And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"

That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.

This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.

Thank you for reading and best of luck on your journey!

William Rahal, MD
Beverly Hills Physician
5.0 out of 5 stars 75 reviews

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

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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)

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.