Our genes determine the shape and size of our breasts, but we can change how they look and feel. Today, a variety of cosmetic (aesthetic) surgery options allow us to create a breast shape and size that is more in line with our body's frame or our personal preference.

The three most common types of aesthetic breast surgery are breast lift, breast augmentation, and breast reduction.

Breast Lifting

Breast Lifts Described

A breast lift, also known as a "mas topexy," is a popular surgical option for women who have sagging breasts due to major weight loss, pregnancy and breastfeeding, menopause, or aging. Breast ptosis is another term for sagging breasts.

The number of breast lifts performed has increased dramatically over the last 20 years. The American Society of Plastic Surgeons (ASPS) reports that approximately 113,000 breast lift procedures were performed in the United States in 2019, representing a 114% increase since 2000.

Breast augmentation and lifts

Breast augmentation is a procedure that increases the size of the breasts. A breast lift differs from an augmentation in that it does not significantly alter the size or shape of the breast. However, a breast lift can be combined with augmentation to achieve the desired results. When the procedures are combined, the breasts will grow in cup size while also being repositioned and reshaped.

Candidates for a Breast Lift

Breast lifts are only done for aesthetic purposes. The pencil test is one quick technique to determine if you are a candidate for a breast lift. Put a pencil as high as you can under one breast's fold; if the pencil stays there, the breast is sagging. A breast lift can be necessary if the pencil is higher than the nipple since that implies sagging. It is advised that a woman postpone a breast lift until after she has finished having children because further pregnancies and breastfeeding could cause the breasts to extend once more.

Breast Lift Procedures

Depending on the quantity of extra skin that needs to be removed as well as the form and placement of the existing breast tissue, surgeons choose from a variety of breast lift techniques. There are three principal choices:

• The "Donut" or Peri-Areolar Lift
   Correcting mild sagging with a single scar, the donut lift involves a circular incision (cut) running around the edge of the areola. The surgery helps reduce areola size and is often used in combination with breast augmentation.
• The "Lollipop" or Vertical Lift
   This kind of breast lift corrects moderate sagging by allowing the physician to remove extra skin and reconstruct your breast with discreet scars. One cut goes around the areola, while the other extends from the bottom of the areola to the fold where the breast and the chest meet, forming a lollipop-shaped incision.
• The "Anchor" or Inverted-T Lift
   The anchor lift significantly reduces extra skin and drooping tissues for women whose breasts are significantly sagging or hanging "pendulous." Three incisions are made during the procedure: one around the areola, one along the inframammary fold, and one from the bottom of the areola to the breast crease (where the breast and chest meet). The anchor lift provides the most breast lift even though it leaves slightly more noticeable scarring than other treatments.

The "crescent" lift is an additional, less popular alternative for women with little drooping to address. Typically performed when women are simultaneously having breast augmentation or to slightly elevate the nipple-areola complex without changing the shape of the breast, the operation entails one small incision running halfway around the top half of the edge of the areola.

Breast Augmentation

Breast Augmentation Explained

Breast augmentation, often known as "mammaplasty," is an outpatient procedure used to increase breast size and produce a more rounded breast shape. The procedure is one of the most efficient treatments to treat breast asymmetry, which occurs when one breast is visibly different in size and form from the other. It can also restore breast volume lost due to pregnancy or weight loss.

Breast augmentation is the most popular cosmetic surgery operation in the United States, according to the ASPS. 299,715 breast augmentation surgeries out of more than 1.8 million cosmetic surgery operations were carried out in 2019.

Candidates for a Breast Augmentation

If you are in good physical health and are not expecting or nursing, breast augmentation is a possibility. According to ASPS research, women between the ages of 20 and 29 and 40 to 54 had the next highest number of breast augmentation surgeries. Women who smoke, have certain medical disorders that make recovery more difficult (such diabetes), interfere with wound healing or blood clotting, or are using medications that reduce the body's ability to fight off disease may be more likely to have a bad surgical outcome.

Augmentation Procedures

Breast augmentation can be done via fat transfer or breast implant surgery. Breast implant surgery is the more popular of these two techniques.

• A pocket is made in each breast during breast implant surgery, either above or below the chest muscle. This enables the physician to use one of three different types of incisions to position and center implants inside each breast:
  • Inframammary (beneath the breast)
  • Axillary (in the underarm)
  • Periareolar (in the tissue surrounding the nipples)

A broad variety of implant options are available to tailor the breast form depending on the desired aesthetic. Breast size can increase by one cup or more with breast implants.

• By injecting fat into the breasts during a fat transfer procedure, doctors can enlarge and fill up the breasts. This works well for ladies who want a relatively small increase in breast size and may require more than one surgery to obtain the desired size.

Implants

According to the U.S. Food and Drug Administration, 5 to 10 million women worldwide have breast implants (FDA). All breast implants have a silicone outer shell, but they vary in shape and filling type, offering a variety of options to suit the demands of each woman.

Implant Filling Types

Saline and silicone gel are the two most common types of filler for breast implants. Both varieties have either smooth or textured shells and come in various sizes. The many implant kinds and their applications are listed below:

• Saline Breast Implants
   Saline implants have a silicone outer shell and sterile seawater inside. While some are prefilled, others are inserted into the surgically made pocket empty and subsequently filled once they are in the breast. Saline implants, which come in various sizes, offer a consistent shape, firmness, and sensation. Should the implant shell leak, the implant will disintegrate and the saline will be naturally absorbed by the body and eliminated.
• Silicone Breast Implants
   Silicone gel, a viscous, sticky fluid that closely resembles the texture of human fat, is prefilled into silicone breast implants. Many ladies think silicone breast implants are more realistic in terms of appearance and feel. Gel that leaks from an implant may stay inside the implant shell or may find its way into the breast implant pocket.

Implant Shapes

Round and teardrop are the two standard shapes for breast implants. Both feature surfaces that are either smooth or rough and come in a wide range of sizes.

• Round Breast Implants
   Saline or silicone can be used to fill round implants, giving them a soft, well-rounded appearance. Higher profile alternatives can produce even greater projection. They are made to make breasts appear bigger at the top region of the breast. Round implants are less prone to wrinkling and pose less of a rotational risk because they are uniformly shaped throughout.
• Anatomical Teardrop Breast Implants

Teardrop implants are frequently referred to as "form-stable" implants because they are filled with a thicker silicone gel that maintains its shape. The benefit of teardrop implants is that they have a natural appearance and feel and mimic the contour of actual breasts. Teardrop implants frequently feature a rough surface that aids in maintaining the implant in the position the surgeon originally intended. However, textured surface implants carry an increased risk of "breast implant related lymphoma," a rare non-lymphoma. Hodgkin's

Implant Risks and Safety
 
 The FDA regulates breast implants as medical devices, and they can only be used after comprehensive safety testing. Before approving an implant, the FDA requires the producer to conduct clinical trials and other studies to show that it is both safe and effective. This procedure is known as the premarket approval process. Post-marketing studies that check on the implant's safety after it has hit the market come after this.

Breast implants can have health hazards, just like any other medical equipment. The longer breast implants are in place, the greater the chance of issues because they are not intended to last a lifetime. The following issues are the most likely ones:

• Capsular contracture, which may cause pain; it can change the breast implant's contour and give it a rigid feel.
• rupture or leakage of implants packed with silicone or saline. Saline implants frequently deflate quickly when they burst. Women might not notice any changes because silicone gel implant rupture is frequently silent.
• Breast pain
• Infection
• Wrinkling of the implant that can be felt or seen through the skin.

Women should be aware that they might eventually require further operations linked to their breast implants.

However, specialized X-rays can be performed. Having breast implants also makes it more challenging to acquire a standard mammography. The FDA advises women who have silicone gel-filled implants should obtain an MRI or ultrasound five to six years after the implant operation, followed by MRI scans every two to three years to look for silent rupture (one that is not causing signs or symptoms). It is important to get rid of ruptured silicone implants as soon as feasible.

Other considerations to be aware of:

• Some women with breast implants may find it harder to successfully breastfeed.
• Additionally, concerns have been raised regarding a potential connection between breast implants and autoimmune illnesses of the connective tissue like lupus, rheumatoid arthritis, and others. The Institute of Medicine conducted a detailed review in 2000 and the FDA conducted an evaluation in 2019 as a result of this issue. The FDA has determined that there is not enough data to support a link between breast implants and autoimmune disorders based on the available information.
• Another area of research focuses on a group of symptoms collectively referred to as "breast implant illness" (BII) and reported by some women who had breast implants for breast augmentation or reconstruction. These symptoms include fatigue, memory loss, rash, photosensitivity, chronic pain, sleep disturbances, and other issues. Although there is no established medical diagnosis for BII, researchers are looking into the variety of symptoms to learn more about their cause.

About Breast Implant Associated Lymphoma

Due to research linking specific silicone-gel and saline breast implants to a rare malignancy termed breast implant-associated anaplastic large cell lymphoma, the FDA amended its safety statement on breast implants in 2019. (BIA-ALCL). BIA-ALCL, a slow-growing cancer of the lymph system rather than the breast tissue that is more common in women with textured implants, is curable in the majority of cases if detected early.

Although it seldom spreads to tissues further away, BIA-ALCL grows in the scar tissue that naturally occurs around the implant and may harm the lymph nodes. Following the healing of surgical incisions, common symptoms include:

• Breast enlargement or swelling
• Hardening of the breast
• Lump in the breast or armpit
• Pain in the area of the beast
• Overlying skin rash
• Asymmetry of the breasts
• A large fluid collection, usually more than a year after receiving the implant

The majority of women with BIA-ALCL respond well to surgery to remove the implant and any surrounding scar tissue. But some female patients also need chemotherapy and radiation treatment. Women are frequently imaged for two years after therapy as part of their monitoring.

The FDA strongly advises all females with implants or considering receiving them to be informed of the dangers and signs of BIA-ALCL.

On July 24, 2019, Allergan issued a voluntary worldwide withdrawal of its Biocell textured breast implants and tissue expanders. Through this withdrawal, Allergan stopped the distribution or sale of all Biocell saline-filled and silicone-filled textured implants and tissue expanders around the world and asked cosmetic surgeons to return any unused Biocell implants to the company. Allergan took this step as a precaution following notification of recently updated global safety information concerning the uncommon incidence of BIA-ALCL provided by the FDA

For women who have Biocell, the FDA concluded that the risk of developing BIA-ALCL is low. Therefore, the agency did not recommend removal of Biocell saline-filled and silicone-filled textured implants. The exception is if a woman with these implants experiences the symptoms of BIA-ALCL. In this case, women are urged to contact their plastic surgeon.

Breast Reduction

Breast Reduction Explained

Breast reduction surgery, also known as reduction mammaplasty, removes extra breast skin, glandular tissue, and fat to make the breasts more proportionate to the rest of the body. This is crucial for women with macromastia, who suffer from physical pain and emotional suffering as a result of the weight of their enormous breasts. However, breast reduction is also performed on women who do not have macromastia but are dissatisfied with the size of their breasts in order to enhance their self-image and their capacity for physical activity.

Candidates for Breast Reduction

Breast reduction is intended for healthy women with macromastia, which is defined as excessively large breasts on a woman of average size. Other females who can benefit from surgery include:

• suffer from shoulder, back, and neck pain brought on by the weight of their breasts
• Have skin discomfort beneath the breast crease and/or shoulder snags from bra straps
• have big breasts that prevent them from engaging in some physical activities.

Reduction Procedures

Any age can undergo breast reduction surgery, which is often carried out in a hospital or outpatient surgical center while the patient is under general anesthesia. To lower the size of each breast, the operation often entails creating incisions (cuts) on the breasts and then removing breast tissue, fat, and skin. The nipple and areola are then moved into their new positions. But occasionally, doctors will employ both the incision procedure and liposuction, or they may only use the latter if the excess skin is not the main cause of the big breast size.

The surgeon may utilize drainage tubes after the procedure, sew up the breasts, and then wrap them in a special gauze. To reduce swelling and provide support for the breasts while they heal, many women choose to wear an elastic bandage or surgical bra. Normal activity restrictions for women last for six weeks, although they can return to work or school in one to two weeks. The total reduction of swelling and the fading of surgical scars can take several months. Although breast shape and size might alter owing to variables including aging and weight gain or loss, the end outcome is typically permanent.

Risks and Safety

The dangers of breast reduction surgery are the same as those of any other major surgery, including bruising, bleeding, infection, a poor rate of wound healing, and a negative anesthetic reaction. Additional dangers include:

• Excess fluid in the breast tissue
• Loss of sensation in the nipples, areola or the breasts
• Cellulitis, or infection of the connective tissue
• Skin discoloration, permanent pigmentation changes, swelling and bruising
• Excessive firmness of the breast
• Temporary or permanent damage to deeper structures, such as nerves, blood vessels, muscles and lungs
• Differences in the size, shape and symmetry of the surgically altered left and right breasts, which might lead to further surgery to improve appearance
• Prominent or thick scars
• The possibility of not being able to breastfeed
• Blood clots, deep vein thrombosis, heart and lung complications

Decision-Making

Learn everything you can about your options and how to choose the best plastic surgeon for you if you're thinking about having surgery to alter the size and form of your breasts. What you need to know to take control of the decision-making process is provided below.

Choosing Your Surgeon

Because every woman's body is different, you should choose a surgeon who specializes in the type of surgery you need and who is qualified, knowledgeable, recommended, and supportive of your needs. Research is needed for this, as well as knowing what to look for.

Read evaluations of local surgeons and ask friends who have had cosmetic breast surgery for referrals as a starting point. Additionally, contact your primary practitioner or gynecologist for recommendations. Once you've narrowed down your choices to a "short list," make an appointment with each potential surgeon so you can ask questions, go over your objectives and worries, and learn more about the procedure and your possibilities.

Preparing for the Consultation

Making the most of these discussions with possible doctors will depend on your understanding of what takes place during a consultation for breast surgery. The surgeon will analyze your medical history, examine, measure, and take pictures of your breasts during the consultation. The surgeon will also inquire about your surgical objectives, go through the available options and the expected outcomes, and cover recovery time, potential risks, probable problems, and costs.

The American Board of Cosmetic Surgery (ABCS) developed a checklist of things to do before and during the consultation in order to make the most of it.

• Wear clothing and underwear that will make getting undressed easier.
• Bring information about medical history with you or ask if you can fill out your medical information in advance.
• Compile a full list of medications and supplements you are taking.
• Write down a list of questions to ask the surgeon and bring the list to the meeting.
• Use the same list of questions for each surgeon you meet with so you can compare the different surgeons' experience, techniques, approaches and personal styles.