Many women who need a breast lift also want more volume. This means they need a lift and a breast implant. But should you do them together or should you “stage” it, with two surgeries, doing the lift first and then at a second surgery do the implant?
Why would we use two surgeries instead of one?
One procedure:
- Benefit is one surgery, one recovery
- Less cost
- Less anesthesia
Two procedures:
- Better accuracy
- Less complications
- Wound separation, nipple loss, bleeding, areola widening, nipple sensation decrease, recurrence of droopiness, poor scarring
- Less risk of revision needed.
So a group out of Missouri and Texas published a study in September 2016 Plastic and Reconstructive Surgery Journal looking at just this. “The Subtleties of Success in Simultaneous Augmentation-Mastopexy.” Their thoughts? Many people state you can’t safely do a breast augmentation and mastopexy at the same time. But staging these procedures makes increased cost, risk, and recovery. They decided to look at the rate of complications across two groups: one who did the lift and augmentation together, and the other who did it as two separate surgeries.
Study:
- One surgeon, consecutive series of each group
- 297 patients
- Follow up 15.5 months
- They examined 16 different complications
- implant related: rippling, rupture, malposition, double bubble, capsular contracture, volume asymmetry, volume insufficiency
- tissue related: wound separation, nipple necrosis, hematoma, areola widening, decreased nipple sensation, recurrence of drooping, poor scarring
Findings?
- Tissue related complications were most common in the combined procedure group.
- The revision rate was 12.4% for the combined group, 8% for the augmentation alone
- Most complications seen were minor.
So thoughts?
Their underlying principle, which I thought was a good one, was if you do a staged procedure, 100% of patients require “reoperation,” as they will for sure have to have 2 surgeries. If you can do it as one surgery, then in their study only 12% required 2 surgeries. No major “disasters” occurred in their series, despite larger implants being placed in the combined procedure group. They do think a two stage procedure may be wise in those who want a very large breast volume/ augmentation, or those with very large areola. They also said their reoperation statistic did not include small little revisions done in the office.
What do I think?
I liked this study. I warn patients it is harder to do a lift with an implant at the same time and get perfect symmetry. When I do lifts, and I do a lot of them, I cannot predict how much the tissue with “settle” with time. The key to this operation is to center the breast tissue over the implant, and achieve symmetry of everything- nipple position, shape, and size. If we do this as 2 separate surgeries, it allows for all of the lift components to settle before you even try to do the implant. Fewer things are shifting parts, so it is easier to do.
All that being said, I tend to get very close most of the time when we do it in one surgery. If there is a little difference in nipple position or scar, if desired, it likely is something that can be fixed with a little nip or tuck in the office, not a big surgery.
Here in the Bay Area, my patients are busy with jobs, kids, and life. Doing one surgery instead of two, one recovery instead of two, is important.
I like this study supported there was little difference in complications between one surgery and two staged surgery.