Breast Augmentation: Cost, Reviews, Photos

Breast Augmentation and Mastopexy, Single vs 2 stage

This is a controversial topic and plastic surgeons tend to disagree on this topic. The fact is that when breast augmentation is performed with mastopexy in a single stage, the risks are higher. How much higher? It really depends on the patient and the skin of your surgeon.

Some surgeons routinely do this procedure in 2 stages others not. I feel that there are some patients that require a two stage procedure, while others can be done in a single stage safely. It all depends on the particular patient and the skin type, the size of the implant and if the patient had previous surgery. (Farbod Esmailian, MD, Toronto Plastic Surgeon)

Combined augmentation and mastopexy

I routinely perform breast augmentation and mastopexy (lift) in one procedure. There are a handful of patients that I see who need such an extreme lift however that I prefer to break this up into two stages.

Without an exam or pictures, I cannot tell you if you are one of those people. (Sacha Obaid, MD, Dallas Plastic Surgeon)

Breast Augmentation and Lift as One vs Two Stages

Some surgeons are confident to perform these procedures at the same time – myself included. It requires good skill and judgement to perform this safely. Breast lift requires removing and tightening the skin (the “Container”), while a breast augmentation fills the volume of the breast (the “Contents”).

Making the Container smaller and increasing the Contents at the same time requires great care. If overdone there can be complications, but if done well it can give beautiful results safely in one operation. (Cory Goldberg, MD)

Can you have a mastopexy with augmentation together? It depends.

Whether a breast augmentation and lift can be performed together is a debated question among plastic surgeons and there is not uniform agreement. In my opinion, these two procedures can be performed simultaneously. If the patient has deflated breasts with excess skin, I feel it is reasonable to perform a lift and augmentation at the same time.

If the breasts are full and will require significant reduction, I would perform a lift/reduction first, and the augmentation would be done at a second stage. The decision on which course to take can only be made after a careful examination and thorough discussion between patient and surgeon. (Brian D. Kent, MD, Tulsa Plastic Surgeon)

Mastopexy with augmentation at the same time after weight loss

This is an issue that really relies heavily on the judgment of your surgeon and your preferences. As I tell all of my patients, we as surgeons can never fully avoid risk, everything we do involves risk, and it is our job simply to manage that risk the best we can.

I can tell you that in general, performing both mastopexy and breast augmentation together increases one’s risk over performing them separately. That’s not to say that there is no risk if they are performed separately, but the risk is diminished I believe. Some of these risks that are improved by staging the procedures are things like loss of skin and nipples, loss of breast tissue, malposition or displacement of implants or breast tissue, and asymmetry.

Accuracy is enhanced by staging the procedures because a mastopexy/augmentation is essentially one of the trickiest operations that I perform on a breast. I am simultaneously adjusting just about every landmark on the breast in relation to the others, like nipple position in relation to the breast, in relation to the chest wall, volume, and position of the breast mound, and I’m doing it on both sides simultaneously and trying to achieve symmetry.

This is not to say that I don’t do these operations together – I do it all the time. What I am saying is that sometimes judgment dictates that I advise the patient that in her particular case our risk would be lessened and our accuracy would be enhanced if we staged the procedures.

My best advice is to discuss this with both doctors in that light, get a feel for their motivations and judgment, and go with the plan and the doctor that feels safest and most comfortable for you. (Joseph L. Grzeskiewicz, MD, San Diego Plastic Surgeon)

The more you have to do, the less safe the procedure becomes. More here meaning more lift, more skin removal, more weight loss, more sagging and more implant volume. If two or more Board Certified Plastic Surgeons say two stages, I would be wary of a single stage procedure. (David Marcus, MD, Santa Rosa Plastic Surgeon)

Augmentation and mastopexy should be done at the same time if both are indicated.

If a breast augmentation is desired and mastopexy is required for a good appearance, I can think of no reason to stagger the operations. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)

Simultaneous augmentation and lift is SUPERIOR to 2 separate operations

Since you have lost weight and have gone from size F to size D, you will certainly need a lift. There are new lift techniques that do not require the vertical scar or the boat anchor shaped incision. With the new techniques, it is possible to maximize the anterior projection of the breast by aligning the areola and the breast tissue over the bony prominence of the chest wall.

However, if it is your desire to be larger, this technique can be combined with an implant. Unfortunately, you have not told us your bra size just your cup size. If you are a 36 or 38 each 200 cc’s of implant corresponds to 1 cup size change. You desire to go up 2 cup sizes so 400 cc’s should be adequate.

A 690 cc implant is quite large and this will not fit retro-pectoral. It that was attempted it would extrude inferiorly and laterally and will need revisions. You may be a candidate for a new technique called Breast Augmentation with Mini Ultimate Breast Lift, which is better than two separate surgeries. (Gary M. Horndeski, MD, Texas Plastic Surgeon)

Augment/Mastopexy; one or two operations?

This is a question that does not have one answer. Too much depends on your individual anatomy and goals and obviously an in person exam would be necessary for your surgeon to discuss your options with you.

As you are aware, you will get different answers from different surgeons.

You need to feel comfortable with the surgeon you choose, make sure he or she is certified by the American Board of Plastic Surgery and that the plan proposed is one that makes sense to you. (Margaret Skiles, MD, Sacramento Plastic Surgeon)

Augmentation and Lift

Some surgeons are reluctant to perform a simultaneous augmentation and lift, citing a revision rate nearing 20%, when each procedure performed separately has a revision rate of approximately 5%. Alternatively, performing the surgeries separately has a 100% revision rate, if you consider the second procedure the revision of the first. I will very often perform both simultaneously, after discussion with my patients about the higher possibility of a second procedure, although still markedly less than performing them separately. (William A. Wallace, MD, FACS, Jacksonville Plastic Surgeon)