There are three general categories of cosmetic surgery performed on the breasts (also called mammoplasty): breast augmentation, breast reduction, and breast reconstruction.
Breast Augmentation (Augmentation Mammoplasty)
Breast augmentation is performed to enhance the appearance, size, and contour of a woman’s breasts. Women consider breast augmentation for many different reasons. Some women feel their breasts are too small. Some desire augmentation after their breasts change after pregnancy. Others desire to correct an asymmetry in breast size.
Breast augmentation is performed with implants that can be placed under a chest muscle or over a chest muscle. The incision can be placed in the axilla (armpit), areola (the area surrounding the nipple), or lower breast fold. In general, all breast augmentations are minimally invasive procedures. For augmentations in which the incision is made in the armpit, an endoscope (thin tube with a small camera and light) may be used during the procedure.
Breast augmentation is a relatively straightforward procedure. As with any surgery, some uncertainty and risk are expected. Know your concerns and expectations. Review the benefits, risks, and alternatives. Seek consultation with a certified plastic surgeon.
Breast reduction surgery is often used in women with large, heavy breasts who experience significant discomfort including neck pain, back pain, and numbness or weakness due to the weight of the breasts. During this procedure, excess skin, fat, and breast tissue are removed.
Breast reconstruction surgery is often performed in women who undergo mastectomy as a treatment for breast cancer.
The procedure recreates a breast with the desired appearance, contour, and volume. The nipple and areola are also recreated. Normal breast sensation and normal breast function, as with nursing, do not usually return when the sensory nerves or milk glands and ducts have been removed or significantly injured.
The appearance, contour, and volume of the breast can be recreated with implants or with a woman’s own tissue. If an implant is used, the implant is sized to match the opposite breast. When possible, the implant is placed beneath a chest muscle. A breast also can be recreated using a woman’s own tissue. At times, a segment of the lower abdominal wall can be used. Other tissue options for autologous (using your own tissue) reconstruction are back muscle and skin or fat and muscle from the buttock. Sometimes surgery on the opposite normal breast will be required to create symmetry with the newly reconstructed breast.
Breast reconstruction can be done at any time after you have had a mastectomy. The procedure has no known effect on the recurrence of cancer and it does not appear to affect cancer surveillance. However, you will be instructed on breast self-exams and scheduled for routine follow-up appointments for surveillance.
Breast Lifts (Mastopexy)
In some women, the skin is not strong or resilient enough to support the weight of the breast, causing the breasts to sag. With this condition, called ptosis, there is too much skin compared to breast tissue. To give the breast a lift, the excess skin must be removed. There are several surgical techniques used including:
- Wise pattern. The incision, in the shape of an anchor, goes around the chest and below the breast.
- LeJeour. The incision goes around the areola and down.
- Donut or peri-areolar. The incision goes around the areola only.
This surgery involves some degree of permanent scarring, but products are available that may help to minimize the appearance of scars.