Breast Lifts with Implants: One or two stage procedure?

New statistics from the American Society of Plastic Surgeons show breast lifts have grown 70% since 2000, outpacing breast implants alone 2-1. Age, pregnancy, breastfeeding, weight fluctuations and gravity can decrease the amount of overall breast tissue making breasts sag. A breast lift raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.

Many patients looking into breast lift surgery also desire implants. Why? Because breast lift surgery does not significantly change the size of the breasts or round out the upper part of the breast. For upper pole fullness and volume, an implant is usually recommended. The question debated by Drs. Pat McGuire of St. Louis and Stafford Broumand of New York City: “Is a lift with augmentation too much surgery to do on the breast all at one time?” 

by The Plastic Surgery Channel
and Stafford Broumand, MD
and Patricia McGuire, MD

The Two Stage Challenge

Dr. McGuire strongly prefers a two stage procedure. “If a patient has weak tissue that wants to sag, but they also need volume, balancing the right amount of volume with the right amount of tightening can be very tricky.” She recommends tightening the tissues first to give patients a nicely shaped breast and add volume in a follow up surgery.

Dr. Broumand treats the majority of his lift/augmentation patients in one operation, primarily because his patients won’t tolerate the idea of two separate procedures. He admits bringing breast tissue and skin up higher while keeping the implant low and natural looking is a challenge. “We have to up our game a bit trying to get accomplished in the same procedure.” He likens it to a teeter-totter. Yet he claims considerable success in tailoring the one stage procedure for his patients. Dr. McGuire is not swayed. She emphasizes getting the balance just right is improbable. “I would rather do two really good operations than one compromising operation.” Dr. Broumand agrees theoretically but not practically. “It is complicated but we have the ability and capability for one operation.”  In an ideal world, he too would like the opportunity to do two stage, but that’s not reality for most of his patients in New York City.

One-Stage Trade-offs

Dr. McGuire supports Dr. Broumand’s experience that there are some candidates with certain tissues and desires whose expectations can be met with one stage, however, “They have to be willing to accept the fact that there is a higher chance of requiring a revisional procedure.”  He agrees one stage can pose higher revision rates overall.

Striving for the Best Results

Both surgeons note that breast lifts with augmentation are a difficult consultation and not an easy “sell.” Patients arrive thinking one surgery will solve all their concerns and are disappointed to hear there might be two procedures. In any case, both doctors stress they are intent on giving their patients the best result for the long term. Sometimes–but not always–that may require a two stage procedure.