Is It Better to Separate a Breast Lift and Implants into Two Procedures?

If your breasts have both dropped and lost volume, the usual answer is a breast lift combined with breast implants. The next question is whether to have them in one operation or to separate them, with the lift first and the implants a few months later.

Neither approach is right for everyone. This guide explains why combining the two is technically demanding, what the evidence says about one stage versus two, and how surgeons decide which suits you. If you’re still working out whether you need a lift, implants or both, start with our guide to breast lift vs breast augmentation, or read about a breast lift without implants.

Can You Have a Breast Lift and Implants at the Same Time?

Yes, and for most women who need both, that is what surgeons recommend. The combined operation is called augmentation mastopexy, or more simply a breast lift with implants. The surgeon lifts and reshapes the breast and places the implant in the same operation, usually through the lift incisions.

At Centre for Surgery, a combined lift and augmentation is performed by a plastic surgeon as a day case under TIVA (total intravenous anaesthesia) and usually takes three to four hours. In a single operation, implants are usually kept to around 360cc. Larger implants are one of the main reasons surgeons suggest splitting the surgery into two stages.

Why Combining a Breast Lift and Implants Is Difficult

A lift and an augmentation ask the skin to do opposite things. The lift removes skin and tightens the breast, while the implant stretches the skin from underneath. Doing both at once puts tension on the healing wounds. In their review of the operation, Spring and colleagues describe it as one of the most difficult cosmetic breast operations for exactly this reason: it aims to add volume and improve shape while making the skin envelope smaller.¹

When the tissue is asked to do too much at once, things can go wrong. The implant may not settle where it should, scars can widen, the nipple position can shift as the implant drops, and the breast may start to sag again sooner than expected. These problems are more likely when the skin is thin, the breasts have dropped a long way, or a large implant is used.

One Stage vs Two Stages: What the Evidence Says

Several large studies have looked at how single-stage operations turn out:

• A systematic review of 23 studies, covering 4,856 single-stage operations, found a pooled complication rate of 13.1% and a reoperation rate of 10.7%. The most common problem was the breast dropping again (5.2%). The authors concluded that with careful patient selection these rates are acceptably low.²
• A 10-year review of 2,183 one-stage operations in 1,131 women found a complication rate of 15.3% and a reoperation rate of 14.7% over an average follow-up of 43 months. The most common reasons for a further operation were the breast dropping again (3.5%) and wanting a different implant size (3.2%). Reoperation was much more likely when the lift was done only around the areola (25.7%), and smokers had more complications (26.1%). The authors concluded that doing both at once can be safe and spares most women a second operation, which staging requires by design.³
• A study of 73,608 cosmetic breast operations found that major complications were uncommon overall (1.46%), but a combined lift and augmentation carried a higher risk than a single breast procedure, particularly of infection.⁴

Put together, the trade-off is clear. Each combined operation is a little riskier than either operation alone, but staging guarantees a second operation. For most women with moderate sagging, good skin and a moderate implant size, one stage makes sense. Staging comes into its own when the tissue makes a combined operation more likely to need revising.

What Is a Two-Stage Breast Lift and Augmentation?

In a staged approach, the lift is done first. The surgeon reshapes the breast, raises the nipple and removes excess skin without an implant stretching the tissue at the same time, so the focus is entirely on creating a good shape.

Around three to six months later, once healing is complete and the breast has settled, the implants are placed in a second operation. By then the surgeon can see how your lifted breast actually looks and choose an implant that complements it, with less guesswork about size, shape and symmetry.

Benefits of Having a Breast Lift First, Then Implants

More Control Over Implant Size and Shape

Doing the lift first shows how your own breast tissue behaves once it has been reshaped. That makes it easier to choose the right implant size, profile and position in the second stage. You might find you need less volume than you expected, or that a different shape suits you better. Our guides to breast implant options and round vs teardrop implants explain the choices.

More Accurate Nipple Position

One of the hardest parts of a combined operation is predicting where the nipple will end up once the implant has settled, because the implant’s weight can shift the nipple after surgery. With two stages, the nipple position is set on a breast without an implant, and any fine-tuning can be done at the second operation.

Less Strain on Healing Tissue

Each operation asks the skin to do only one thing: tighten in the first stage, stretch in the second. This reduces tension on the wounds, which matters most when the skin is thin or has lost elasticity. Any problems with healing after the lift, such as slow wound healing or scar quality, can be dealt with before implants are added.

You Can Stop After the Lift

Some women find they’re happy with how their lifted breasts look and decide they don’t want implants after all. A staged plan leaves that choice open.

Downsides of Separating a Breast Lift and Implants

Two Operations and Two Recoveries

Staging means two anaesthetics, two operations and two recovery periods to plan around, time off work and help at home included. Each operation carries its own risks.

A Wait of Several Months

You’ll live with lifted but unaugmented breasts for three to six months. That can be hard if more volume was your main goal.

Higher Overall Cost

Two operations mean two sets of fees, so staging usually costs more in total than a single combined operation. Prices are quoted after your consultation. See our breast lift cost guide and breast augmentation cost guide for what affects the price.

Who Should Have a Breast Lift and Implants in Two Stages?

Your surgeon is more likely to suggest two stages if:

• your breasts have dropped a long way, with the nipple well below the crease under the breast. Our guide to breast ptosis grades explains how sagging is measured.
• your skin is thin, heavily stretch-marked or has lost elasticity, which is common after major weight loss or pregnancy and breastfeeding.
• you want implants larger than around 360cc.
• there is a marked difference between your breasts, or you have tuberous breasts, where the shape of each breast needs correcting separately. See our page on breast asymmetry correction.
• you’ve had breast surgery before, particularly if existing implants are being removed or replaced. See implant removal with a breast lift.

Who Can Have Both in One Operation?

A single operation usually suits you if your breasts have dropped mildly or moderately, your skin is in reasonable condition, you want a moderate implant size, and you don’t smoke or can stop for four weeks before and four weeks after surgery. Most women who need a lift and implants fall into this group. The final decision is made at your consultation, once your surgeon has examined you.

How Long Should You Wait Between a Breast Lift and Implants?

Usually three to six months. That gives the swelling time to settle, the scars time to start maturing and the breast time to reach its new shape, so the implant can be chosen for the breast you actually have. Your surgeon will confirm the timing at your review after the lift.

Recovery After Each Stage

At Centre for Surgery, both stages are day cases under TIVA, and recovery follows the same pattern after each:

• 7 to 10 days: wound check, and most patients return to desk work.
• 4 to 6 weeks: physical work that involves lifting.
• 6 weeks: after your surgeon review, full exercise including upper-body work. A surgical bra is worn day and night until then.

The implant operation is usually shorter than the lift. For the week-by-week detail, see our breast lift recovery and breast augmentation recovery guides, and our guide to breast lift scars.

Breast Lift With Implants Before and After

These are Centre for Surgery patients who have consented to their photographs being used. Individual results vary.

You can see more results in our breast lift before and after and breast augmentation before and after galleries.

Frequently Asked Questions

Breast Lift and Implants at Centre for Surgery

At Centre for Surgery, breast lifts, breast augmentation and combined procedures are performed by GMC-registered plastic surgeons at our CQC-regulated hospital at 95–97 Baker Street, rated Good overall. The surgeon who assesses you at your consultation is the same surgeon who performs your surgery, and we recommend a two-week cooling-off period before any surgery is booked. For an overview of every option, see our guide to cosmetic breast reshaping. Our medical content is reviewed by Specialist Plastic Surgeon Dr Spyridon Vlachos (GMC 7522950).

Read verified patient reviews on Google or on our patient reviews page. To book a consultation, call 020 7993 4849 or complete the form below.

References

1. Spring MA, Hartmann EC, Stevens WG. Strategies and challenges in simultaneous augmentation mastopexy. Clin Plast Surg. 2015;42(4):505–518. doi:10.1016/j.cps.2015.06.008
2. Khavanin N, Jordan SW, Rambachan A, Kim JYS. A systematic review of single-stage augmentation-mastopexy. Plast Reconstr Surg. 2014;134(5):922–931. doi:10.1097/PRS.0000000000000582
3. Messa CA 3rd, Messa CA Jr. One-stage augmentation mastopexy: a retrospective ten-year review of 2183 consecutive procedures. Aesthet Surg J. 2019;39(12):1352–1367. doi:10.1093/asj/sjz143
4. Gupta V, Yeslev M, Winocour J, et al. Aesthetic breast surgery and concomitant procedures: incidence and risk factors for major complications in 73,608 cases. Aesthet Surg J. 2017;37(5):515–527. doi:10.1093/asj/sjw238