Q for gals who've had 2-step mastopexy then augmentation

I had a very informative phone consult with my PS this week about breast lift and augmentation. I had sent him photos and notes of the look that I want to achieve, along with photos and notes of looks that I do not like.

I am fairly large-chested and have significant ptosis (sagging). He would like to move forward with doing the surgery in two-steps. The first would be the lift. Then 3-mos later he would do the implants. 

I asked if what I sent him as my desired look is achievable. He did not say yes or no but rather he replied that he would need to show me photos of women who had the two step procedure because the results look somewhat different from women who get inserts only or who do the lift and aug at the same time.

So now I am very curious about this. I'd love to hear from anyone who has had the two step lift and implants. How do they look different from other breast augs? Do you love your results?

Thanks a bunch!

My surgeon also does them in 2 steps for those of us with long folds (super saggy, as I call it). I've had step 1 and saving for step 2. From what I understand, it helps them stay up in place better and not sag back down.

Thanks, Laura. It is good to hear from you again. The two step procedure is recommended as the preferred method by the ASPS. It make a lot of sense to perform my surgery this way -- I have a lot of sag, and I want large implants so they would be pushing against the lift and nipple incisions creating two opposing forces thus making for increased risk of complication and undesirable esthetic outcomes. Often times it requires a revision surgery if done in one step.

I was delighted when my surgeon suggested the 2-step procedure without any provocation from me. And since I want other surgeries it is easy to combine the lift with another contouring procedure and the implants with something else.

I am just really curious how the final results look different when done this way. I have no idea what he meant by that and at the time I did not think to ask for clarification.

Ick, tired of hearing how saggy my boobs are! 

Just my personal opinion, but we do a lot of these, and I can't remember the last time I suggested a two stage procedure quite honestly and I think that most people doing a lot of bariatric patients do not break these into stages unless they're thinking you likely won't need an implant but aren't certain (which I do sometimes). The significant cost and multiple recoveries is a lot to lay on most patient's doing these procedures, and quite honestly I don't think it's really any easier. I'd rather have an opportunity for a small revision with an implant already in place rather then  having to deconstruct a mastopexy to introduce an implant and still potentially have to revise that.

Thanks for sharing your perspective. I appreciate it and you have given me something to think about and discuss with my surgeon. I find your insight particularly interesting because my surgeon commented that maybe I only need a lift... I believe that he thinks I am fairly well endowed already. So I will need to make sure that he knows I am clear on wanting to be larger (the lift will make me smaller). That said, I think that my surgeon knows me pretty well and is making this recommendation with some thought to my emotional well-being. 

I did speak with another surgeon and he cited the same best practices for doing it in two stages... BUT he said there was a 50-50 chance it would not need a revision so he said he'd roll the dice and do it in one stage, playing the odds that I'd be happy with the results.

Again, I appreciate you sharing your perspective with me!!! I definitely will discuss this with my surgeon.

 

As you say, he may be thinking you won't need an implant which is a pretty common rationale to present things for me (you're better off without one if possible generally speaking). Again, the cost of multiple surgeries is such a real world consideration that 2 stage surgery is just pretty rare.

Thanks for the follow-up reply. I read your blog posts and they are quite intesting and helpful, especially those on augmentation. You have piqued my interest again. Why is it that I am better off without the implants? I spent a lot of time discussing safety with my surgeon. I had a lot of concern in this area.

are you on Twitter?

I asked this question on Real Self and got a few insightful replies from surgeons. You may read it here if interested: http://www.realself.com/question/scars-medial-thigh-lift