4 things to know before getting an Augmentation-lift

Augmentation-lift (also called augmentation mastopexy or aug-pexy) is a surgery that does two things at the same time. First, it lifts and reshape sagging breasts by removing excess, stretched-out skin (this is the lift part). Second, it enhances the upper half of the breast with an implant (this is the augmentation part). Aug-pexy is ideal for patients who have lost breast volume after pregnancy or breast feeding, and also have sagging breasts due to stretched out skin. Many “mommy makeover” procedures will include an augmentation-lift.

From a patient perspective, there are four things you should know about this very popular procedure.

1. It saves you time and money

This is one of the reasons the surgery is as popular as it is. The alternative to the aug-pexy is to have a breast lift first, and then a few months later have a breast augmentation. Two surgeries means two sets of bills. It also means two recoveries and more time off work or away from your normal routine. Combining the surgeries into a single procedure can save you a ton of money, pain, and time.

Augmentation-lift is a delicate balancing actA delicate balance

2. It’s a balancing act

In a previous post, I wrote about a framework for understanding breast surgery. That framework involved thinking about two things: breast skin and tissue. An aug-pexy tries to fix both these aspects at the same time. Unfortunately this is less like walking and chewing gum, and more like driving and talking on the phone. If you’re not careful, things can go wrong. Reducing skin and adding an implant at the same time is a tug of war between the skin and the tissue. Reduce the skin too much, and the implant will be too tight and the skin won’t heal well. Place too small an implant, and the breast will sag off the implant and not look very good at all. It’s important that your surgeon have a detailed discussion with you about how this balance will be achieved.

3. Not everyone can have this surgery

Aug-pexy is a fantastic option and many patients are great candidates. Unfortunately, a few patients just can’t have this combined surgery. During the lift part of the surgery, the nipple is usually returned to its original, youthful position. The more the nipple has to move (i.e., the more the breast has sagged), the more stretched-out the blood supply to the nipple becomes. In addition, the implant squeezes the nipple from the inside, reducing the blood flow to it further. As a result, in some patients, doing the combined surgery has the risk of causing the nipple skin to lose its blood supply. Needless to say, this is not something you want to have happen to you. So make sure you discuss with your surgeon what his or her criteria are for deciding which patients shouldn’t have the combined surgery. Remember that even if you can’t have the combined surgery, you can still have the two procedures (lift and augmentation) as two separate surgeries a few months apart.

Augmentation-lift may require a second surgery for the best resultPerfect symmetry only exists artificially

4. You might need a second surgery

The whole point of the aug-pexy is to avoid two separate surgeries. And for most patients, one surgery is enough. However, some patients who undergo an aug-pexy might still end up having a second surgery. Usually this second surgery is a touch-up of some kind. Most often, the reason for the second surgery is something to do with the implant. For example, the implant may be slightly too big, or too small. Or there may be some slight asymmetry of the breasts that needs to be fixed. Usually the second surgery is a smaller procedure with a faster recovery. So although the large majority of patients don’t need a second surgery, keep in mind that there is a small chance of needing it.


Augmentation-lift is a great option for a lot of patients. However, it is important to understand its limitations and risks. The decisions that go into designing this surgery are relatively complex. Remember to have a detailed discussion with your surgeon about the surgical plan and how these decisions will be made.

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