).Combining mastopexy with augmentation is a technically demanding procedure, associated with relatively high revision rates and the potential for significant wound-healing complications that lead to poor results, high patient dissatisfaction, and litigation. 1-3 The combination of two procedures on the breast simultaneously makes the ultimate outcome less predictable as tissue compliance is subject to the competing forces of the implant expanding the soft tissue, while the skin excision and breast lift compresses it.This ultimately reduces vascularity to the skin flaps and the nipple-areolar complex (NAC), creating the potential for major wound-healing complications. In addition, as the implant settles and the skin envelope relaxes, there is a greater chance for recurrent ptosis, asymmetry, and implant malposition as compared with either procedure alone. In addition, in an effort to protect vascularity, there may be a morecautioned approach to skin flap dissection and lifting, creating a greater potential need for a secondary lift as follow-up of each patient progresses over enough time to allow soft tissuecompliance issues to manifest.Numerous references in the literature highlight the higher risk associated with this procedure in an effort to caution the plastic surgeon before proceeding with this procedure without due respect for the potential adverse consequences. [2][3][4] The cautionary language in publications such as "Augmentation/Mastopexy: Surgeon Beware" and "Secondary Mastopexy in the Augmented Patient: A Recipe for Disaster" is incisive and appropriate. 1,2In a candid 3-year review of 166 combined augmentation/ mastopexy cases, Spear reported a 17% complication rate in primary augmentation/mastopexy and a 23% complication rate in secondary augmentation/mastopexy. 5 In another study, Stevens found a 14.6% revision rate in 321 patients with most attributed to implant-related issues rather than soft tissue complications. 6 In a more recent study, Stevens reported a 16.9% revision rate in 615 patients evenly Keywords ► augmentation mastopexy ► delayed implant fill ► breast revision AbstractCombining breast augmentation with mastopexy is a challenging procedure that has a relatively high revision rate in the literature. Some surgeons prefer a two-stage procedure to avoid the potential for skin flap or nipple-areolar complex necrosis that can occur with a one-stage procedure. The authors compared 101 patients who had subpectoral breast augmentation with immediate implant fill and mastopexy with 203 patients who had subpectoral breast augmentation with delayed (10-14 days) implant fill and mastopexy. They found the revision rate for immediate implant fill was 24%; in the delayed implant fill group, the revision rate was 10.3%. Patients had soft tissuerelated complications in 16% of the immediate fill group and in 2% of the delayed fill group. Delaying implant fill in combined breast augmentation mastopexy significantly reduces the risk of soft tissue-related complications and revision procedures; the dela...