Background: Single stage breast augmentation and mastopexy has been fraught with complications. The difficulty of combining gland augmentation and skin reduction raises concerns for nipple-areolar necrosis and implant malposition. The surgeon must often “convince” the patient that two operations are better than one. Massive weight loss patients may have severe breast deformities that are often dealt with in staged operations; however, we present a single stage operation as a viable alternative.

Objective: To review the surgeon's technique, results and complications in massive weight loss patients undergoing single stage breast augmentation and mastopexy.

Methods: Forty-six patients, the majority of whom had Grade III ptosis, underwent single stage augmentation and mastopexy over a period of three years. Sub-muscular augmentation was performed first, followed by Wise pattern mastopexy. Forty-one patients underwent additional concurrent body contouring procedures.

Results: No patient suffered total nipple-areolar loss, however one patient (2%) had partial loss of one areola. Four patients (9%) required return to the operating room for reasons such as implant deflation (1 patient), implant infection (1 patient), and implant malposition (2 patients).

Conclusion: Single stage sub-muscular breast augmentation and mastopexy may be performed with an acceptable complication rate in the massive weight loss patient.