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 47

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
5.0 out of 5 stars 40 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.

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
5.0 out of 5 stars 119 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.

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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 89 reviews

Do You Need Two Surgeries for Breast Lift and Augmentation?

Breast lift with an augmentation (mastopexy augmentation) is an incredible procedure that can dramatically improve the shape and size of a woman’s breasts. The vast majority of breasts lifts can be done at the same time as the augmentation; occasionally in extreme cases patients will need to have the two procedures done in separate settings.

A breast lift will tighten and shape the breast, while the augmentation will give the breast a more full and youthful appearance. There is a limitation to the size of the breast implant that can be used with a lift and augmentation when they are done in the same setting as your surgeon is doing two opposing procedures, tightening the breast and increasing the size.

A breast lift with augmentation is great for patients who have both lost volume in their breasts and the breasts have fallen. Obviously the benefit of doing both procedures at the same time is that patients can avoid a second surgery. With that said I would follow your surgeon’s recommendations, as they will typically recommend two surgeries if they think that will help you avoid any problems following your surgery.

Please consult with your board certified plastic surgeon to help guide you through your breast lift and augmentation (mastopexy augmentation) surgery.

Breast Augmentation and Implants in two stages.

Dr. Teitelbaum has given an excellent and thorough answer to this question. 
I see many women looking to reduce the size of implants that are too large for their bodies. I would also ask women to carefully consider whether or not they really want large implants.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 86 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
4.5 out of 5 stars 28 reviews

Do you need two surgeries for breast lift and augmentation?

Thank you for your question.  Typically, breast augmentations and lifts can be performed in one surgery and is completely safe. There may be some concerns that your plastic surgeon has that he/she has recommended two separate procedures. If you don't feel comfortable going through two procedures, you may want to seek out another board certified plastic surgeon in your area for a second opinion. Best of luck to you.

John A. Kotis, DO, FACS, FACOS
Chicago Plastic Surgeon
5.0 out of 5 stars 12 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.