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Study Suggests Safety of Combined Breast Lift and Augmentation Procedures

No increase in complications seen with simultaneous versus staged procedures

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American Society of Plastic Surgeons (ASPS)
January 2, 2013

Breast lift surgery and breast augmentation with implants can safely be performed in a single procedure, according to a report in the January issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"With appropriate patient selection and a carefully planned operative approach, our data demonstrates a one-stage procedure can be safely performed with acceptable complication and reoperation rates," concludes the study by ASPS Member Surgeon Michael Bradley Calobrace, MD, of Louisville, Ky., and colleagues.

Can breast lifting and augmentation be safely done in one operation?

The researchers review their experience with performing breast lift surgery (mastopexy) and breast augmentation in a single procedure. Of the 430 breast lift procedures performed between 2005 and 2009, breast augmentation using implants was performed at the same time in 332 cases.

The average age of the women was 47 years and about one-third were undergoing reoperation after previous cosmetic plastic surgery to the breasts. To determine the safety of performing combined breast lift/augmentation, Dr. Calobrace and colleagues assessed the rates of complications and reoperations.

The overall complication rate for women undergoing simultaneous breast lift/augmentation procedures was about 23%. The most common complications were hardening (contracture) of the capsule around the implant, scarring and recurrent ptosis (drooping) of the breasts.

The same problems were also the main causes of reoperation after simultaneous breast lift/augmentation. Both complications and reoperation were more common in women undergoing secondary, rather than primary, breast plastic surgery procedures.

In a comparison group of women undergoing breast lift surgery only, the reoperation rate was about 10%. This was not significantly different from the 13% rate of reoperation for tissue-related problems in women undergoing combined surgery.

The other reoperations in women undergoing combined breast lift/augmentation surgery were related to problems with the implants. Thus "the revision rate of combining the procedures is not more than additive in this study," according to the authors.

Breast augmentation and breast lift surgery are among the most common cosmetic plastic surgery procedures. Performing the two procedures in a single operation poses additional technical challenges to the plastic surgeon. It has even been suggested that the two procedures not be performed simultaneously.

However, there are important advantages to lifting and enlarging the breasts at the same time-it is less expensive, avoids the risks of two surgeries and avoids living with disappointing results between procedures. "In our experience, patients overwhelmingly prefer not to undergo a staged procedure and rather have the augmentation and mastopexy concurrently," Dr. Calobrace and coauthors write.

They believe their experience supports the safety of performing a breast lift and augmentation in the same procedure. While the risk of complications and/or reoperation is significant, the risks don't appear any higher than those of the two procedures performed separately.

Dr. Calobrace and colleagues also acknowledge the challenges inherent in the simultaneous approach, which should be considered in preoperative counseling with the patient. However, they write, "with careful consideration of the perioperative decision making and operative approach, our data demonstrates the effectiveness of a one-stage procedure with acceptable complication and reoperation rates."

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