In recent years, there have been more women than ever having breast surgery including two stage breast lift and implants (mastopexy and augmentation mammoplasty) and breast reduction mammoplasty and implants. In particular, older women, women with children, and women with excessive breast tissue have seen a huge increase as the stigma surrounding plastic surgery dissipates. Alongside this trend is the increase in more “complex” procedures. More complex cases relate to patients that have breast laxity, excessive breast tissue, or significant asymmetry (generally women who have breastfed, lost weight, are older, or have genetically very large breasts). In these more complex cases, a breast reduction mammoplasty or lift mastopexy may be required, and in many cases, patients will want an implant as well to achieve upper-pole fullness. These combination procedures (breast lift mastopexy, augmentation mammoplasty, or reduction mammoplasty) are extremely subjective to each patient, and require more surgical planning to execute successfully.
A question that all plastic surgeons are constantly asking is “How do we optimise results?” For combined breast procedures, a course of action has developed over the past decade. This has been in line with practitioner experience and research. This course of action concerns performing breast lift (mastopexy) and implants (mammoplasty) in two stages. This blog post aims to firstly understand what two-stage breast surgery is. We then review pros and cons of both one and two-stage surgery. Finally, we consider the ways to move forward if you have been offered the choice.
What does two stage breast lift and implants (mastopexy and augmentation mammoplasty) mean?
Combined procedures such as breast lift and implants (augmentation mammoplasty and mastopexy) can be done in either one or two stages. In a one stage procedure, the two desired procedures are all performed in the same surgery. The patient will only need to have one surgery and recovery. In a two-stage procedure, the patient will undergo the mastopexy or reduction mammoplasty in the first surgery. They will undergo the standard recovery for this standalone procedure. Then, after 3-6 months they will have a second surgery. This will be the breast augmentation mammoplasty surgery, where implants are placed in the new breast pocket. There are a number of reasons a patient may be recommended a two-stage procedure.
Why would a patient need a two stage breast surgery?
Breast implants are a prosthetic device that not only increase size, but also add extra weight to the breast. Any implant will exert pressure on the lower-pole of the breast, so there is always a risk of an implant causing, or exacerbating breast laxity. For patients that have great skin integrity and limited breast tissue, breast implant weight is generally minimal concern. As such, the longevity of results has a promising outlook.
In contrast, for patients that are prone to breast laxity, have poor skin quality, or require a breast lift mastopexy or reduction mammoplasty, the breast implant weight is more likely to stretch out the lower-pole of the breast and cause breast ptosis. The long-term outlook for these patients is less promising, as implant weight can continue to stretch the lower-pole over time. The below image illustrates how a breast reduction mammoplasty or breast lift mastopexy works, and how the implant can impact results.
A key strategy to improving long-term results is to perform the first and second procedures in two separate stages. The idea is that if the surgeon lifts and reduces the breast first, they can create a more suitable breast size and shape in which the implant can be inserted later. But why do we have to wait a number of months before the implant surgery? This is because scar tissue needs to form within the pocket, which will provide support for an implant. Scar tissue forms over time during recovery. This is why patients will have a first stage surgery, and then wait a number of months before implantation.
In this scenario, the breast pocket is able to heal, scar tissue is able to form, and the breasts are able to settle into their position to create a strong, stable foundation for stage 2. This stable foundation will provide additional support to the breast implant and reduce the risk of breast laxity or ptosis.
Prioritising Patients
Another reason a surgeon might suggest a two stage procedure is because they feel that the patient will get a good result from just a single surgery. Dr. Phil Richardson from Brisbane Plastic & Cosmetic Surgery stresses the importance of transparency and mitigating risk. If Dr. Richardson feels he can avoid unnecessary surgery, he will suggest a two stage procedure so that the patient can assess their aesthetic results after their first surgery and make an informed decision as to whether they would like implants or not. Consequently, the two-stage procedure is often an option for patients that are on the fence, or that the surgeon feels will obtain a great result without the help of a prosthetic.
What are the pros and cons of a one stage vs. two stage?
Ultimately, the decision to have a one stage or two stage procedure is—in most cases—up to the patient. The surgeon will discuss their recommendations and allow the patient to decide which avenue they would prefer. To make an informed decision, an understanding of the pros and cons of each approach is required.
One-Stage Breast Surgery: Pros & Cons
| Pros | Cons |
| – One surgery, one recovery | -Increased risk of laxity |
| – Financially more viable in the short-term | – May require a breast revision which incurs a financial cost |
| – More viable for planning including work leave, help with children, time off other activities etc. | – Potentially diminished aesthetic outcomes due to lack of lower-pole support |
Two-Stage Breast Surgery: Pros & Cons
| Pros | Cons |
| – More promising aesthetic outcome, with the lower pole supporting the breast in a more lifted position. | – Two separate surgeries, two separate recoveries |
| – Better longevity of results | – Greater financial cost in the short-term. |
| – Less likely to experience complications such as bottoming-out and breast droop | – No guarantee that you will not require a revision |
| – Potentially lower long-term costs because revision is less likely. |
Equipped with the above knowledge, patients should be able to strategically consider their options and discover the most appropriate course of action for their goals and lifestyle.
Conclusion
Combination breast surgeries can be complex and there are many more risks and details to consider and understand than compared to a standard breast augmentation mammoplasty. If your surgeon presents you with the option to choose a one stage or two stage breast procedure, you should firstly ensure that you engage in meaningful discussion. Then, weigh up the pros and cons. You should ask all the questions you have, and take the time to make an informed decision.
If you have any questions regarding breast surgery, or would like to organise a consultation with a Brisbane breast specialist, contact us today.