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Staged procedure and "thin skin"

Q:

1. We all know that the term thin skin is a metaphor for lack of breast tissue but why would my wife's surgeon insist on a staged procedure (mastopexy then augment)? 2. She desires her augment size increased from an A to D can this be done without staging the mastopexy and augment? Why? We do not have the time for a staged procedure as we are military.

A:

 

 If you take a big implant and put it ion a large bag of skin then, the patient can end up with what is called a “ball in a sack” and/ or "bottoming out".  Patients typical do not like this result and it can be somewhat difficult to correct. The ball in the sac is much more common in patients with breast ptosis or droopy breasts/ nipples. Many practitioners prefer to complete a major mastopexy or breast lift before an augmentation. This allows for the removal of the excess skin and positioning the nipples to a more youthful position. The overall complication rate can be much lower and the long term results can be better with a staged procedures. Consider getting a second option with one of the many members of the ASAPS. Best,

 

 

Gary R Culbertson, MD, FACS

A:

Staging a breast augmentation and mastopexy (lift) is a personal choice of the surgeon and usually based on their experience. It is my experience that it is very rare that the two cannot be done at the same time. This does take extra time and care in the OR, since one must sit the patient up and remark the nipple/areola  after the augmentation before final closure. If time is a real issue, discuss this with the surgeon you have chosen, or see someone else. Just make sure that whomever you see has significant experience with doing the two procedures at the same time.

A:

The two procedures can be done in one stage. In fact going from cup A to cup D one may need the skin envelope to fill and accommodate the implant. It is a bit more difficult and more complex. There is a slightly higher risk of complications. But a good preoperative evaluation and planning will make the surgery more successful.

A:

Hi Tim,

I have done hundreds of augmentation/mastopexies during my 20 years in practice.  I have done them both staged and at the same time.  I used to think that they should be done at the same time if at all possible but have now changed my preference in most cases to staging the procedures.  my reason for this stems from the fact that augmentation/mastopexy patients are one of two groups of patients who have a higher likelihood of not being fully satisfied with the long term result.  They will often complain that their breasts are no longer up where that were right after the surgery.  If your wife's surgeon does the surgery all at once, going up to a D cup, then he can only remove as much skin as can be removed with the large implant in place.  Starting the day after surgery, gravity will take over and the breasts will begin to drop. Because she is "thin skinned"  this settling will be even more pronounced over time.  If you allow him to stage the procedure, the he will be able to remove the maximum amount of skin while reshaping the breast and repostioning the nipples.  When he places the implants at a later date, the result will be much tighter and will tend to hold up longer.  When I explain this to my patients they usually agree and go for the staged procedure.  Some patients are simply unwilling to go through two operations and I am willing  to do a single stage on them as long as they understand the trade off of of a shorter lived result.  In my hands I have not found the combined procedure to be any more risky, I just ant my patients to be happy with their results for as long as possible.  Hope that helps.

Lars P. Enevoldsen, M.D. - View Other Answers by this Doctor
Modesto, CA

A:

Staged Breast Augmentation/Mastopexy versus One Procedure – This is all very dependent upon the patient’s exam and chest wall dimensions. However, one can safely perform an augmentation/mastopexy if one does not oversize the aug/pexy and cause a deformity or problems with skin compromise. This needs to be performed in the hands of an experienced surgeon with expertise in breast re-shaping, especially augmentation/mastopexy.

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