Your Guide to Each Type of Breast Surgery
If you are unhappy with the size or shape of your breasts, don’t worry – you’re not alone. Many other women feel exactly the same way. Luckily, there are several surgical procedures you can choose from to achieve the results you’re looking for. Whether you are considering a breast augmentation, breast reduction, or breast lift, you most likely have plenty of questions.
Choosing A Plastic Surgeon
Regardless of the type of breast surgery you are contemplating, selecting the right board-certified plastic surgeon should be a top priority. This will not only ensure that you achieve the desired results, but that your procedure is done safely by an experienced professional. Above all, your plastic surgeon should be board certified by the American Board of Plastic Surgery. Visit the New York page of the American Board of Medical Specialties website to confirm.
You should also verify the surgeon’s experience. When meeting with a potential plastic surgeon, there are several questions you should ask:
• How frequently do you perform the specific type of surgery you’re considering?
• How many total procedures have you performed?
• What are the names of the hospitals where you have privileges? (A lack of hospital privileges can be a warning sign to stay away.)
Reviews and testimonials from former clients are also a great way to determine whether or not a surgeon is the right one for you.
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An augmentation mammoplasty, more commonly known as a breast augmentation or breast enlargement, is the most popular cosmetic surgery for women. According to the American Society of Plastic Surgeons’ “2016 Plastic Surgery Statistics Report,” 290,467 people underwent breast augmentation, a 4% increase from 2015. Breast augmentation can increase breast size, correct breast asymmetry, and/or restore breast volume lost as a result of pregnancy, breastfeeding, or significant weight loss.
WHO IS THIS SURGERY BEST FOR?
There is no “perfect” candidate for a breast augmentation, and there are many reasons why women choose this procedure. Some simply wish to increase their breast size to achieve the figure they have always desired, while others want to restore their breast size typically lost after pregnancy or from weight loss. Breast augmentation can change the shape of your breasts and improve asymmetry, so it is a viable option for women seeking a more balanced appearance.
TYPES OF IMPLANTS
There are several breast implant options to choose from to achieve your ideal feel, texture, size, and shape. It is always beneficial to discuss with your surgeon to find the best option for you.
An affordable option, saline breast implants are circular or tear-shaped, are filled with sterile saltwater, and are FDA-approved for women over the age of 18. Since the silicone shell is first inserted into the breast prior to inflation, it requires a smaller incision than other implants. The deflated shell is then filled with a specified amount of saline to achieve its desired size.
It is important to note that there are several drawbacks to saline implants, including its higher risk of rippling compared to silicone gel implants.
Silicone breast implants are circular or tear-shaped, and are filled with silicone gel. They feel more like real breasts, yet unlike saline implants, these are pre-filled and cannot be altered for size. Since silicone does not deflate like a saline implant, an imaging study, such as a mammogram or MRI, will be required to determine if there are any ruptures.
• GUMMY BEARS
One of the newest implant options available are form-stable implants, known as “Gummy Bear” breast implants. These are constructed from a highly cohesive silicone gel that is thicker than regular silicone gel implants, giving a firmer feel (like a Gummy Bear). Both round and shaped Gummy Bear implants are now available.
“It’s a nicer implant, and a thicker gel implant,” explains Robert A. Jacobs, M.D., F.A.C.S., Board Certified Plastic Surgeon from Cosmetic Surgery of NY. “People were nervous about gel leakage, so they made the gel a little thicker and it holds its shape a little better, so it’s nicer for shaped implants.”
They are also less likely to fold, ripple, or leak. These implants do, however, require a slightly longer incision, which can result in elongated scarring.
• IDEAL IMPLANTS
Ideal Implants are only available through a limited network of board-certified plastic surgeons. Ideal Implants have advantages over silicone gel implants. They have the natural feel of silicone gel, and because they are filled with saline, there is no need for an MRI to assess the implant if it has ruptured.
Ideal Implants are made from a series of implant shells, with two separate chambers that hold saline. These control the saline movement and support the implant edges to reduce folding and wrinkling. The Ideal Implant has also been designed to contour to the natural curve of the chest wall and has a similar feel as silicone gel.
• AUGMENTATION MAMMAPLASTY WITH FAT TRANSPLANTATION (LIPOSUCTION)
A breast augmentation with fat transplantation differs from other procedures because there are no actual implants. This procedure uses liposuction to extract excess fat from other parts of the body, which is then injected into the breasts. The result is a less-dramatic increase in breast size, yet with a natural look and feel.
Since some of the fat may die from a lack of blood flow during the transplant, the end result of this type of breast augmentation may vary. Unlike an implant in which you know its exact size, breast volume from a fat transplant is more unpredictable; therefore, there is no certainty when it comes to the size, shape, appearance, or symmetry of your breasts.
There is also a chance the fat may be reabsorbed by your body, resulting in a reduction in breast size over time, as well as greater difficulty in detecting breast cancer.
PLACEMENT OF BREAST IMPLANTS
Deciding where your breast implants will be placed is another important decision you will make with the guidance of your board certified plastic surgeon. The best placement depends on the size of the implants, your anatomy, and the desired results you hope to achieve.
• SUBGLANDULAR IMPLANT PLACEMENT
The implant is positioned under your breast tissue, but above your pectoral and chest muscles.
• PARTIAL SUBMUSCULAR IMPLANT PLACEMENT
The implant is positioned beneath your breast tissue, and partially beneath your pectoral and chest muscles.
• FULL SUBMUSCULAR IMPLANT PLACEMENT
The implant is positioned under your pectoral and chest muscles.
PLACEMENT OF SURGICAL INCISIONS
Since there will be scarring, choosing where your surgical incisions are is another important decision. Your board-certified plastic surgeon will help you determine the best location for the type of implants you have chosen.
• INFRAMAMMARY INCISION
The surgeon makes incisions under the breasts, in, or just above the folds where the breasts meet your body. This will leave a thin, 1- to 2-inch scar.
• PERIAREOLAR INCISION
The surgeon makes incisions along the edges of the areolas (nipples), so the scar is hidden within its natural skin pigmentation. This is the same incision type often used for a breast lift, in addition to an augmentation. Periareolar incisions are often inconspicuous.
• TRANSAXILLARY INCISION
The surgeon makes well-concealed incisions in your underarm area. Since this scars the armpit, it is the best option for women who do not want scars on their breasts. Due to its difficult positioning, you should discuss with your board certified plastic surgeon the possibility of uneven implants.
THE BASICS OF SURGERY
You and your board-certified plastic surgeon will discuss your desired breast size, implant type, and incision locations beforehand. Your surgeon will explain the procedure, its risks, and the recovery process.
On the day of the surgery, general anesthesia will be administered prior to the procedure. An implant pocket will be created, and the surgeon will insert the implants, either under your breast tissue or the beneath the muscle behind the breast. The procedure typically takes an hour, and you will be able to go home the very same day.
BREAST AUGMENTATION RECOVERY
Immediately following your surgery, you will wear a support bra. Since you will be under anesthesia, once out of recovery, you will need to have a friend or family member drive you home.
Once home, you will be advised to take it easy for the first few days, slowly returning to your normal routine as the swelling subsides and healing begins. Please note that you must avoid heavy lifting and strenuous exercise for several weeks. During this time, visit your doctor for follow-up appointments.
Pregnancy, weight loss, and/or menopause may influence the appearance of your augmented breasts. Consult with your surgeon if you experience changes in the size or shape of your breasts.
A reduction mammoplasty, or breast reduction, is a procedure that reduces the size and weight of large, heavy breasts. By removing excess breast tissue, fat, and sagging skin, your breasts will be smaller, lighter and firmer. This can help relieve the physical and emotional strains of large breasts.
WHO IS THIS SURGERY BEST FOR?
Large breasts can be physically uncomfortable. Women with large breasts often experience neck and back pain and have trouble feeling comfortable in bras and other form-fitting clothing.
A breast reduction can help alleviate related back, neck or shoulder pain, including shoulder grooves or discomfort while exercising. A breast reduction can also assist those uncomfortable with their body image. Breast reduction can create a more aesthetically pleasing breast contour that is better proportioned to your body.
It is important to note that breast reduction is not recommended for women who intend to breastfeed, since many of the milk ducts leading to the nipples are removed.
THE BASICS OF SURGERY
Performed under general anesthesia, a breast reduction is a two- to three-hour procedure that removes fat and glandular tissue and tightens skin to produce smaller, lighter breasts that are in better proportion to the rest of the body. In most cases, the nipple will be moved higher up on the breast, or the areolas reduced, to be more proportional to the new breast size.
BREAST REDUCTION OPTIONS
In some cases, a breast reduction can be performed using liposuction alone. This is a less-invasive procedure that leaves virtually no scarring. It is best for candidates who need only a slight reduction, have good skin elasticity, and little to no sagging.
• VERTICAL OR “LOLLIPOP” BREAST REDUCTION
This type of reduction requires two incision sites: one around the edge of the areola (nipple), and the second running vertically from the bottom of the areola to the inframammary fold (the crease beneath the breast). These incisions enable the surgeon to remove extra fat, skin and tissue, while also reshaping and lifting the breast into a new position. This procedure is recommended for those who need a slight to moderate breast reduction, experience slight sagging, stretched skin, or asymmetrical breasts. The scarring for this procedure is less than with a full lift.
• INVERTED-T OR “ANCHOR” BREAST REDUCTION
This reduction involves three incisions: one around the edge of the areola, one vertically from the areola to the breast crease, and one along the inframammary fold (the crease beneath the breast). These incisions facilitate maximum tissue removal and reshaping, making it ideal for candidates who need a significant breast reduction or have sagging or asymmetric breasts. The scarring from this procedure involves more than other techniques, but results in a more complete reduction (and lift.)
BREAST REDUCTION RECOVERY
Since a breast reduction surgery is typically performed as an outpatient procedure using general anesthesia, you can go home the same day. Your incisions will be properly covered and dressed in bandages, and you will be asked to wear a surgical bra. You can expect moderate pain for several days following the procedure. Your surgeon will advise when you can resume normal physical activities.
Many patients can return to their normal lives after one week, and can begin to resume exercise (other than walking) after three or four weeks.
This procedure will not prevent your breasts from aging naturally. Future pregnancies are likely to alter the shape, size, and appearance of your breasts, and may even reverse some of the breast reduction-related changes. On rare occasions, breast reduction surgery may have to be performed again, depending upon breast enlargement.
Breast lift, also known as mastopexy, is a surgical procedure to elevate and reshape breasts that have sagged as a result of aging, pregnancy, weight loss, gravity, or other factors. By removing excess skin and tightening the surrounding tissue, a breast lift can help restore a more proportionate, youthful breast appearance—with breasts that are higher on the chest. The areola can also be repositioned or resized for further enhancement.
Since a breast lift does not alter breast size, many patients choose to combine this procedure with a breast augmentation or reduction to achieve desired results.
WHO IS THIS SURGERY BEST FOR?
A breast lift is an effective procedure for many women seeking to enhance the appearance of their drooping breasts, although there are certain restrictions on eligibility.
Ideal candidates for a breast lift include women with:
- • Sagging breasts
- • Breasts that have lost shape or volume
- • Breasts that are flat or elongated
- • Nipples or areolas pointing downward
- • One breast lower than the other
THE BASICS OF SURGERY
This procedure is performed on an outpatient basis under general anesthesia and usually takes one to two hours. Depending on the size and shape of the breasts, as well as the degree of sagging and amount of excess skin, your surgeon will determine an appropriate approach for the procedure.
After the incisions are made, breast tissue is reshaped to achieve the desired breast contour. The nipple and areola may be moved higher on the breast or resized as well. Finally, any excess skin is trimmed to create a tighter, more defined appearance. When the breast lift is complete, the incisions are closed with absorbable sutures beneath the skin.
BREAST LIFT OPTIONS
There are several different incisions that can be made for a breast lift, depending on the patient’s breast tissue, end goals, and the amount of skin requiring removal. Your plastic surgeon will help you choose the best option.
• PERIAREOLAR OR “DONUT” LIFT
This type of breast lift is most suited for women experiencing mild sagging. It requires a circular incision around the areola, resulting in a single scar around its edge. The periareolar lift is commonly combined with a breast augmentation.
• VERTICAL OR “LOLLIPOP” LIFT
Best for slight sagging and more extensive reshaping, the vertical lift involves two incisions: one around the edge of the areola, and another running vertically from its bottom to the inframammary fold.
• INVERTED T OR “ANCHOR” LIFT
Optimal for correcting significant sagging and providing dramatic reshaping, this option involves three incisions: around the areola’s edges, vertically from its bottom to the breast crease, and along the inframammary fold. These scars will fade over time.
BREAST LIFT RECOVERY
Patients will likely experience bruising, soreness and swelling for several days following a breast lift. A surgical bra should typically be worn for about a week post-surgery, followed by a support bra worn continuously for a month. It is normal to experience moderate pain after the surgery. Sutures will be beneath the skin and are dissolvable.
Most patients will be able to return to work within a week, although exercise and other strenuous activity should be avoided for about a month. Your surgeon will provide specific instructions for your recovery.
The results of a breast lift are visible immediately after surgery, and will continue to improve as swelling subsides and scars fade. Your breasts will still experience the normal changes associated with aging, pregnancy, or fluctuations in weight.