Breast Lift and Augmentation Surgery (Combined)

The two most common aesthetic issues women experience with their breasts over time are sagging (ptosis) and volume loss (deflation). Especially after pregnancy, breastfeeding, or significant weight fluctuations, breast tissue both loses its elasticity, causing it to droop, and loses its internal fullness.

At this point, patients can become confused: Do I need a Breast Lift, or do I need a Breast Augmentation?

If your breasts are only sagging but have sufficient volume, a breast lift alone may be adequate. If your breasts are not sagging but are small, breast augmentation (with an implant) is the solution. However, for a vast majority of patients, especially in the post-partum period, both problems exist simultaneously: The breasts are both sagging and deflated.

In this situation, a single procedure is insufficient. Placing only an implant will pull the sagging skin further down (the "snoopy deformity"); performing only a lift will raise the breast but will not fill the empty, deflated upper pole. For these patients, the ideal solution is the Breast Lift with Augmentation (Augmentation-Mastopexy) surgery, which combines the power of both operations.

So, how are these two comprehensive surgeries safely combined into a single session? How does the process work? In this article, from the expert perspective of Plastic Surgeon Assoc. Prof. Dr. Yalçın Bayram, we explore all the details of this popular combination surgery.

What is Augmentation-Mastopexy? (Two Surgeries in One)

Augmentation-Mastopexy is a combination surgery performed in a single surgical session, encompassing both the Breast Augmentation procedure (placing a silicone implant) and the Breast Lift (Mastopexy) procedure (removing excess skin and repositioning the nipple).

The primary goal of this surgery is to both restore ideal volume to the breast and lift it to its ideal position. This is one of the most frequently performed breast aesthetic procedures by surgeons because it simultaneously solves the two main problems created by post-pregnancy body changes.

Who is an Ideal Candidate for Combined Breast Surgery?

This combination surgery is designed for women experiencing the following issues at the same time:

• Breast Sagging (Ptosis): Those whose nipples are at or below the level of the under-breast fold.

• Breast Volume Loss: Those who feel their breasts are "empty" or "deflated," especially noting a flatness in the upper pole or cleavage area.

• Post-Pregnancy and Breastfeeding: This is the most common group of candidates for this combination surgery.

• Significant Weight Loss: Patients often experience both sagging and volume loss after post-bariatric surgery or significant dieting.

As with other surgeries, it is expected that the patient is close to their ideal weight and stable, does not smoke, and is in good general health.

How is Breast Lift with Augmentation Surgery Planned?

Planning for this combination surgery is more complex than for a single procedure because the surgeon must simultaneously decide on both the implant size and the amount of skin to be removed.

During the consultation, Assoc. Prof. Dr. Yalçın Bayram will evaluate the degree of sagging (degree of ptosis) and the amount of existing breast tissue. Based on this evaluation, two critical decisions are made:

1. Which Implant Will Be Used? (The Augmentation Part)

• A round or teardrop (anatomical) implant is selected based on the patient's expectations and existing tissue. If the patient desires significant upper pole fullness, round implants may be preferred. If a more natural transition is desired, teardrop implants are often chosen.

• The implant size (cc) is determined based on the patient's chest wall structure and desired size.

2. Which Lift Technique (Scar) Will Be Used? (The Lift Part)

• Since the implant itself creates a slight "lifting" effect, the required lift incision may sometimes be shorter.

• Lollipop (Vertical) Scar: This is the preferred technique for moderate sagging. The scar is located around the areola and in a vertical line descending from the areola to the breast crease.

• Inverted-T (Anchor) Scar: This is used for more advanced sagging (where the nipple is far below the breast fold) or in cases combined with Breast Reduction. The scar includes the lollipop incision plus a horizontal scar hidden in the breast crease.

The Stages of Breast Augmentation with Lift Surgery

This combination surgery is performed under general anesthesia and typically lasts 3 to 4 hours. The sequence of steps may vary based on the surgeon's preference, but generally, the steps are as follows:

1. Making the Incisions: The pre-planned (Lollipop or Inverted-T) lift incisions are made.

2. Creating the Implant Pocket: The "pocket" where the implant will be placed is prepared through the incision. Options for the pocket include over the muscle, under the muscle, under the muscle fascia, or dual plane. The Dual Plane (Double Plane) is the most frequently preferred implant pocket. In this technique, the upper part of the implant is placed under the chest muscle, and the lower part is placed under the breast gland.

3. Placing the Implant: The selected breast implant is placed into the prepared pocket. This immediately restores lost volume and upper pole fullness.

4. The Lift (Skin and Nipple): After the implant is placed, the excess skin is removed according to the breast's new volume. The breast tissue is reshaped around the implant, and the nipple (areola) complex is moved to its new, higher, and more youthful position.

5. Closure: All incisions are meticulously closed with aesthetic sutures to ensure the scars heal as inconspicuously as possible.

Recovery Process for Combined Surgery: What to Expect?

The recovery process for a breast lift with augmentation is slightly longer than for augmentation alone, but much shorter than undergoing the two surgeries separately.

• First Week: A 1-night hospital stay is generally sufficient. Drains (to evacuate fluid) may be used and are typically removed 1-2 days later. Pain, swelling, and bruising are normal for the first few days. Arm movement is restricted.

• 2-6 Weeks (Critical Period): Wearing a medical compression bra is mandatory during this period. This bra both keeps the implant in the correct position and supports the lift incisions. Patients can often return to desk jobs within 7-10 days.

• 6-8 Weeks: Heavy lifting and strenuous sports (especially those working the chest muscles) must be avoided. Light exercises can be started after 6-8 weeks with doctor's approval.

• Final Result: It may take 6 months to 1 year for the breasts to fully "settle," soften, the implant to take its natural form, and the scars to begin maturing.

Frequently Asked Questions About Augmentation-Mastopexy

Why is placing only an implant in a sagging breast insufficient?

This is the most common question from patients. The answer is the risk of the "Snoopy Deformity." If an implant is placed in a sagging breast (where the skin envelope is loose and the nipple points down), the heavy implant sinks with gravity while the breast tissue "slides" off the implant and sags over it. This results in an artificial look where the top is full, but the bottom sags and the nipple points downward, like "Snoopy's nose." It is essential that the excess skin is also removed (the lift).

Does this breast augmentation and lift combination surgery prevent breastfeeding?

Both procedures (augmentation and lift) are performed with modern techniques that show maximum respect for the milk ducts and glands. Breast augmentation (submuscular or dual plane) does not affect breastfeeding. While a breast lift can affect some milk ducts when the nipple is repositioned, the potential for breastfeeding is largely preserved. The preservation rate is much higher compared to a breast reduction surgery.

Is it riskier to have both surgeries at the same time?

No. Breast augmentation and lifting are complementary procedures performed in the same anatomical area. While the general anesthesia time is slightly longer than for a single procedure (like augmentation only), this duration is well within safe limits. Undergoing these two surgeries separately (two anesthesias, two separate recovery periods) would be both more taxing on the patient and more costly. However, if the degree of breast sagging is severe, performing the lift and augmentation in the same session can cause problems with nipple blood circulation, potentially leading to nipple necrosis. In such cases, it is advisable to perform the lift first and the augmentation 6 months later.

Is it possible to have breasts that are both full and lifted?

Yes. Especially if you are unhappy with an "empty and sagging" breast appearance after childbirth, the Breast Lift with Augmentation (Augmentation-Mastopexy) surgery is the most ideal and comprehensive solution for you.

If you are only experiencing volume loss, you can review our main Breast Augmentation service page. If you only have a sagging problem, you can review our main Breast Lift service page.