The Benefits Of Combining A Breast Augmentation And Breast Lift

When it comes to cosmetic breast surgeries, there are three main types of procedures: breast augmentation, breast reduction, and breast lift. The first two deal with size. We probably don’t need to tell you that breast augmentation increases the size of the breasts, while a breast reduction reduces it. A breast lift, meanwhile, specifically addresses breast ptosis (or sagging), and it can be performed alone or as a complement to other breast surgeries.

During the COVID-19 pandemic, doubling up on procedures offered a way to maximize time. But, in the case of many combos, the coupling also maximizes results. Exhibit A: breasts. “Breast reshaping has become more and more popular with refinements in technique, technology, and pain control limiting downtime and improving patient experience,” says Ryan Neinstein, MD, a board certified plastic and reconstructive surgeon in New York City.

For some women, combining a breast augmentation and breast lift is the best way to achieve their aesthetic goals. So, what makes someone a candidate for the duo and how does the combined procedure and recovery differ from solo surgeries? We asked the experts.

Breast Augmentation vs. Breast Lift: What’s the Difference?

Before you can understand the benefits of pairing them, you first need to understand what makes each procedure unique. Also known as augmentation mammoplasty, breast augmentation refers to surgery that increases the size of the breast. There are three ways to do so:

1. Breast Implants
2. Fat Transfer
3. A hybrid of the two

Most commonly, breast augmentation involves placing silicone or saline breast implants under the breast tissue or pectoral muscle. In a breast augmentation with fat transfer, fat is liposuctioned from one part of the body (think: the abdomen or thighs), purified, and then injected into the breast to add volume. It is considered a natural alternative to implants, though only patients with enough body fat qualify. Lastly, a hybrid breast augmentation uses fat injections to smooth and perfect the appearance of implants for a more natural effect.

A mastopexy (a.k.a. breast lift) is a procedure that addresses breast ptosis (read: drooping or sagging). Depending on the degree of ptosis, a non-surgical, radiofrequency (RF) breast lift may be enough to restore a perkier contour. For more advanced cases, there are an array of surgical techniques to lift the breasts. During a surgical breast lift, one or more incisions are made to remove excess breast skin and breast tissue and shift the areola and nipple into a higher position. Deep tissue sutures are then used to support the new breast positioning.

The Ideal Candidate for a Breast Augmentation + Breast Lift

For the most part, any healthy individual who is interested in a breast augmentation is generally a candidate for it. The parameters for a breast lift are a little more specific. To determine if you are a good fit, a plastic surgeon will examine the shape of the breast and the position of the nipple and areola relative to the inframammary fold, or the lower part of the breast where it meets the chest. The degree of breast ptosis (as classified on a three-grade scale) is determined based on where the nipple sits relative to the fold.

This combination of surgeries tends to be best for patients who have lost volume and have saggy skin, says Lisa Cassileth, MD, a board certified plastic and reconstructive surgeon in Beverly Hills. As Dr. Neinstein explains, it’s not uncommon for women to seek to address these concerns simultaneously — especially at certain times in their life. “After breastfeeding and pregnancy, many women will feel as though their breasts are deflated and lack a youthful look and feel,” he says. “For others, weight loss or genetics may be the driving force behind their breast changes that drive them to seek enhancement.”

Who Isn’t a Candidate for Combining These Procedures?

While it can be transformative for some patients, it’s not a given that a breast lift needs to be combined with a breast augmentation (or vice versa). “It isn’t necessary to do a breast augmentation to get a lift,” Dr. Cassileth notes. “So, this is only for patients that want more volume.”

Breast surgery — make that any surgery — can be overwhelming, and patients who are not physically and/or emotionally prepared should defer. “Patients with unrealistic expectations whereby they are hoping either a lift or augmentation alone will completely attain their desired goals should not seek surgery,” Dr. Neinstein says. Additionally, depending on the breast lift technique employed, visible scarring is possible. “Lifts entail scarring, which will have a different psychological burden on different people,” he adds.

To ensure the most desirable outcome, it’s important for providers and patients to be on the same page. “It is essential to develop a therapeutic alliance with the surgeon in order to completely grasp all the risks, benefits, and alternatives to the desired procedure,” Dr. Neinstein shares.

How to Prep for a Breast Augmentation + Breast Lift

The lead-up to a combined breast augmentation and breast lift procedure is not unlike most other cosmetic surgeries. “Typically, the patient must avoid aspirin, ibuprofen and other blood-thinning medication for one to two weeks prior to surgery,” Dr. Cassileth says. “All herbals that may thin the blood, like ginger and ginkgo, must be stopped as well.” In addition, alcohol should be avoided for one week prior to surgery.

Typically, after thorough evaluation and consultation, the patient can proceed to surgery, Dr. Neinstein adds. Patients over 40 will obtain a baseline mammogram, along with standard pre-operative assessment. That includes discussing the patient’s aesthetic goals, so that an implant can be chosen. “A size, based on patient individual characteristics and desires, will be chosen preoperatively,” he adds.

The Breast Augmentation + Breast Lift Procedure Process

As Dr. Neinstein explains, the surgery will begin with the augmentation. In the majority of patients, he places smooth, round silicone gel implants under the pec muscle. Alternatively, saline implants or the patient’s own fat can be used to augment the breasts.

After the breast augmentation is completed, the lift is performed. “While surgeons will perform preoperative markings, the dynamics of the patient will change in surgery and the surgical plan must be re-evaluated,” Dr. Neinstein says. Most likely, either a lollipop or anchor-pattern lift will be performed. “The lollipop lift is typically used for shorter distance lifts compared to the anchor pattern, which allows greater movement and reshaping,” he explains. The nipple and areola are typically pivoted up, “dissolving sutures are placed, and long-acting numbing is strategically placed to enhance the healing process,” Dr. Neinstein adds.

Recovering from a Breast Augmentation + Breast Lift

Adding a lift to augmentation tends to extend the healing time that each individual procedure would take. “This is because the procedure is longer and, therefore, the inflammation and stretch on the tissues is increased,” Dr. Neinstein explains. “Combining procedures, however, allows patients to meet multiple objectives within one procedure and limits the overall downtime and psychological burden associated with surgery.” Dr. Cassileth agrees. “Recovery is similar for both procedures, so we always perform them together in our practice,” she shares.

One thing to keep in mind? “If done together, extra care is taken to make sure to supply the nipple with continued good blood flow, as the mastopexy and the augmentation both can decrease blood flow to the nipple,” Dr. Cassileth cautions. Otherwise, the recovery process tends to mimic those of the solo surgeries.

When recovering from a combined breast augmentation and breast lift, patients can usually expect to be sore for a week, but they should be off all pain medication — except the occasional acetaminophen (Tylenol) and ibuprofen (Motrin) — by the second week, Dr. Cassileth says. An ointment is used on the incisions for about 14 days, before being swapped out for a special scar cream to minimize the appearance of post-op marks. Most patients will wear a soft sports bra for the first three weeks, Dr. Neinstein adds.

Patients can return to work after three or four days and do light activities in three weeks, Dr. Neinstein notes. Normal exercise can usually be resumed four to six weeks post-op. Results are immediate — save for post-op swelling — with full healing three to six months after surgery.