It’s not unusual to see women who have breast hypoplasia associated with breast sag. The majority of these women present because of changes in their bodies which occur because of pregnancy. During pregnancy, their breasts increase in size and after pregnancy, they shrink. This often leads to loss of breast volume and resultant skin sag.
To correct this problem, patients will require breast augmentation with a breast lift. There are basically two approaches to performing these two procedures. The first involves a single stage procedure in which breast lift and augmentation are performed simultaneously. The second involves a two-stage procedure in which the breast lift and breast augmentation are performed at two separate settings.
The issue of one or two stages for breast augmentation and breast lift continues to represent an area of significant controversy in plastic surgery. This appears to be driven by the large number of variables involved with breast augmentation and breast lift. Some surgeons feel that the additive impact of these variables results in a high revision rate. Some surgeons feel that this may be as high as 20%.
Many surgeons feel that the high rate of revision with this combination of procedures is too high. For these reasons, they prefer to stage these procedures. They typically prefer to perform the breast lift first and then follow with a secondary breast augmentation. They feel that by utilizing this approach, they can control multiple variables and provide an excellent satisfaction rate. The obvious disadvantage of this approach is that 100% of the patients will require two procedures, two recoveries and ultimately more expense.
Another group of surgeons feel strongly that a single, combined procedure is appropriate. They argue that the majority of patients following this approach have a good result. The 20% of patients who require a secondary procedure would have had a secondary procedure anyway if a two stage approach had been utilized. Not only do the majority of patients only have one procedure, but they also only have one recovery and incur less expense.
Ultimately, the type of approach utilized depends upon the patient. Many patients are motivated to undergo a single combined procedure for social reasons. Time off work, child care and the day to day stress of normal life are powerful motivators. When patients choose this approach, it’s important for them to realize that a secondary revision procedure may be necessary. Under these circumstances, they must understand that this doesn’t mean an error has been made, but instead that we’re dealing with a very complex set of variables.