No Increase in Complications with Simultaneous Versus Staged Procedures

Arlington Heights, Ill. - 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 women's average age was 47 years; 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 percent. 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.

Risks 'No More than Additive,' Results Suggest
In a comparison group of women undergoing breast lift surgery only, the reoperation rate was about 10 percent. This was not significantly different from the 13 percent 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."

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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