Overview

Our genes may be responsible for the breasts we were born with, but we still have ways to change how our breasts look and feel. Today, a range of cosmetic (aesthetic) surgery options make it possible to create a breast shape and size that better matches our body's frame or our personal preference.

Here is an overview of the three types of aesthetic breast surgeries –breast lift, breast augmentation and breast reduction.

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Breast Lift

Breast Lifts Explained

Sometimes called breast rejuvenation, a breast lift or "mastopexy" is a popular surgical option for women who have sagging breasts due to major weight loss, pregnancy and breastfeeding, or menopause. Sagging breasts also may be called breast ptosis. Breast lifts are typically performed as an outpatient procedure and take about one to two hours. The procedure raises the breasts and tightens the surrounding tissue to restore the breasts to a perkier, more youthful shape. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast. Over the last 20 years, the number of breast lifts performed has increased dramatically. According to statistics from the American Society of Plastic Surgeons (ASPS), almost 110,000 breast lift procedures were performed in the US in 2018, a jump of 105 percent since 2000.

Breast Lifts and Breast Augmentation

Breast augmentation is a procedure that increases breast size. A breast lift differs from an augmentation in that it does not significantly change the size or round out the upper part of the breast. However, there are times when a breast lift is performed together with breast augmentation to get the results a woman wants. When the two procedures are combined, breasts will increase in cup size while also positioning the breasts correctly and giving them shape.

Candidates for a Breast Lift

One easy way to find out if you are a good candidate for a breast lift is the pencil test. Put a pencil as high as possible under the fold of one breast and if its stays there, that is a sign of breast drooping. If the pencil is higher than the nipple, that indicates a lot of sagging, meaning a breast lift would be beneficial. However, the procedure is not recommended if you plan to have more children: another pregnancy and breastfeeding will only stretch the breasts again.

Breast Lift Procedures

Surgeons opt for different breast lift procedures based on the amount of excess skin to be removed and the existing breast tissue. There are three main options:

  • 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
    Correcting moderate sagging, this type of breast lift allows the surgeon to remove excess skin and reshape your breast with easily hidden scars. The procedure involves two incisions that create a lollipop shape: one cut is around the edge of the areola and the other runs down from the bottom of the areola to the fold where the breast and the chest meet (called the inframammary fold).
  • The "Anchor" or Inverted-T Lift
    For women with considerable sagging or hanging "pendulous" breasts (where the nipple and the lower breast mass are below the breast crease line on the chest), the anchor lift removes a lot of excess skin and sagging tissues. The technique involves three incisions: one around the edge of the areola, one that goes down from the bottom of the areola to the breast crease, and one along the inframammary fold. Although the anchor lift comes with visible scarring, it allows for the maximum breast lift.

Another less frequent option is the "crescent" lift for women with little sagging to correct. The procedure involves one small incision running halfway around the top half of the edge of the areola and is mostly done when women are also having breast augmentation.

Risks and Safety

Even though breast lift surgery is typically very safe, the procedure comes with the risk of bleeding, infection and an adverse reaction to anesthesia.

It is also possible to have:

  • Permanent scarring, although scars will soften and fade in one to two years.
  • Changes in nipple or breast sensation. In most situations, sensation returns within several weeks.
  • Partial or total loss of the nipple or areola. This rare complication is caused when the blood supply to the nipple or areola is interrupted during surgery.
  • Irregularities in the shape and size of the breasts and uneven breasts as a result of changes during the healing process.
  • Difficulty breastfeeding. While breastfeeding is usually possible after a breast lift, some women may have difficulty producing enough milk.

Breast Augmentation

Breast Augmentation Explained

Often called a "boob job," breast augmentation or "mammaplasty" is performed on an outpatient basis to increase breast size and achieve a more rounded breast shape. The surgery can also restore breast volume lost after weight loss or pregnancy and is one of the most effective ways to correct breast asymmetry (when one breast is noticeably different in size and shape than the other). According to the American Society of Plastic Surgeons (ASPS), breast augmentation is the top cosmetic surgical procedure in the US. Of the more than 1.8 million cosmetic surgical procedures performed in 2018, 313,735 were for breast augmentation.

Candidates for a Breast Augmentation

Breast augmentation is an option if you are physically healthy and are not pregnant or breastfeeding. Based on research from ASPS, women ages 30-39 have the highest number of breast augmentation procedures, followed by women ages 40-54 and those ages 20-29.

Augmentation Procedures

There are two ways of performing breast augmentation: breast implant surgery or fat transfer. Of these two methods, breast implant surgery is the most common.

Breast implant surgery involves separating the breast tissue from the chest muscle and surrounding tissue and creating a pocket in each breast. This allows the surgeon to place and center the implants inside each breast using one of three types of incisions:

  • Inframammary (beneath the breast)
  • Axillary (in the underarm)
  • Periareolar (in the tissue surrounding the nipples)

Depending on the desired look, a wide range of implant choices are available to customize the breast shape. Breast implants can expand breast size by a cup or more.

During fat transfer surgery (the other type of augmentation), surgeons take fat from other parts of the body and inject it into the breasts to make them bigger and fuller. This works best in women who are looking for a relatively small increase in breast size.

IMPLANTS

Approximately 5 to 10 million women worldwide have breast implants, according to the US Food and Drug Administration (FDA). All breast implants have an outer shell made of silicone but they differ in design and the filling materials used, providing a range of options tailored to meet each woman's individual needs.

Implant Filling Types

Today, there are four general types of breast implants:

  • Saline Breast Implants
    Saline implants are filled with sterile salt water. They are inserted empty into the pocket created during the augmentation surgery and then filled once they are in place in the breast. FDA-approved for augmentation in women ages 18 and above, saline implants provide a uniform shape, firmness and feel. Should the implant shell leak, the implant will collapse, and the saline will be absorbed and naturally expelled by
    the body.
  • Structured Saline Breast Implants
    Structured implants are also filled with sterile salt water but have a different internal structure that reduces the folding and wrinkling of traditional saline implants and makes the implant appear more natural. Structured implants are also approved for augmentation in women ages 18 and above.
  • Silicone Breast Implants
    FDA-approved for augmentation in women ages 22 and above, silicone breast implants are pre-filled with silicone gel, a thick, sticky fluid that closely mimics the feel of human fat. Many women believe that silicone breast implants look and feel more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel will not collapse.
  • Gummy Bear Breast Implants
    Officially known as stable implants, "gummy bear" implants are pre-filled with an extra thick silicone gel that sticks together, is firm and has a consistency like the gummy bear candy. Approved for augmentation in women ages 22 and above, gummy bear implants keep their shape even if the implant shell is broken. They also are teardrop-shaped, meaning they have more projection (project forward from the chest providing a larger profile) and are tapered towards the top. However, putting in gummy bear implants requires a slightly longer incision in the skin.

Implant Shapes

Along with the filling type, breast implants come in three types:

  • Round Breast Implants
    Round implants are designed to make breasts appear fuller at the top portion of the breast and higher profile options can achieve even more projection. Because round implants are the same shape all over, there is less concern about them rotating out of place.
  • Smooth Breast Implants
  • Smooth breast implants feel the softest. Because they have an outer silicone rubber shell that is exceptionally smooth, shiny and slippery, these implants do not attach to the surrounding body tissue so they can move freely within the breast implant pocket, giving them more natural movement. However, there is some risk of visible folds or ripples.
  • Textured Breast Implants
  • Unlike smooth-surfaced implants, textured breast implants have a rough surface that is sometimes compared to sandpaper. By giving the implant a slight roughness, the surface of the implant sticks to the tissue around it, keeping the implant in its original position created by the surgeon. However, there is a higher risk of "breast implant associated lymphoma" (BIA-ALCL), a rare type of non-Hodgkin's lymphoma, with textured surface implants.

Implant Risks and Safety

Breast implants are medical devices that are regulated by the FDA and only approved after extensive safety testing. Under what is called the Premarket Approval Process (PMA), the FDA requires the manufacturer to conduct clinical trials and other studies before approval to demonstrate that the implant is safe and effective. This is followed by post-marketing studies that monitor the safety of the implant once it is on the market.

As is the case with other medical devices, the FDA makes clear that all breast implants pose health risks. Further, because breast implants are not designed to last a lifetime, the risk of complications goes up the longer the implants are in place. The most likely complications include:

  • Scar tissue that distorts the shape of the breast implant (capsular contracture)
  • Rupture of the saline or silicone-filled implants or implant leakage
  • Changes in nipple and breast sensation, which are often temporary
  • Breast pain
  • Infection

At the same time, having breast implants makes it more difficult to get a routine mammogram, but special x-rays can be taken. It is also harder for some women with breast implants to breastfeed. Women who have silicone gel-filled implants will also need to get an MRI scan three years after the implant surgery and then MRI scans about every two years to check for silent rupture (one that is not causing signs or symptoms).

Besides these complications, questions have been raised about a possible link between breast implants and such conditions as lupus, rheumatoid arthritis and other connective tissue (autoimmune) diseases. This concern has prompted extensive scientific research, including a thorough review by the Institute of Medicine (IOM) in 2000 and an FDA evaluation in 2019. Based on the evidence to date, the FDA concludes there is not enough evidence to show an association between breast implants and autoimmune diseases.

The scientific community is also investigating a cluster of symptoms collectively called "breast implant illness" or BII, which have been reported by some women who received breast implants for breast augmentation. BII is not a recognized medical condition in terms of diagnosis, but researchers are examining the range of symptoms – fatigue, memory loss, rash, chronic pain, sleep disturbances and other problems – to better understand their origins.

About Breast Implant Associated Lymphoma (BIA-ALCL)

In 2019, the FDA updated its safety information on breast implants due to research establishing a link between certain saline and silicone-gel breast implants and a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Found in women with textured (have a rough surface) implants, BIA-ALCL is not a cancer of the breast tissue. Rather, it is a slow-growing cancer of the lymph system that when caught early, can be cured in most women.

BIA-ALCL develops in the scar tissue that naturally forms around the implant and may affect the lymph nodes but rarely spreads to tissues further away. Common symptoms include:

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

In most women, BIA-ALCL is treated successfully with surgery to remove the implant and surrounding scar tissue. However, some women also require chemotherapy and radiation therapy. Following treatment, women are commonly followed for two years with imaging tests.

The FDA urges all women who have implants or are thinking about getting them to be aware of the risks and symptoms 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. Allergan's announcement with the list of the recalled implants is here.

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, which include pain, lumps, swelling, fluid collections or unexpected changes in breast shape, including asymmetry. In this case, women are urged to contact their plastic surgeon.

More information about BIA-ALCL is available at PlasticSurgery.org/ALCL. This includes links to FDA resources that provide recommendations for patients with BIOCELL® textured implants, as well as recommendations for health care providers and anyone with implants in general.

AFTER SURGERY CARE

Because every woman's body is different, there is no universal length of time for recovery from breast augmentation. According to ASPS, a full recovery takes an average of six weeks, but some women may feel fine after about a week.

Post-recovery, practicing good breast implant maintenance is the key to keeping breasts healthy and ensuring that the implants last for many years. Although breast implants do not last a lifetime, ASPS reports that implants today can be expected to last more than a decade. Thus, the goal of breast implant maintenance is to catch problems early. This entails:

  • Scheduling regular follow-up visits with the plastic surgeon
  • Having a clinical breast exam by a health professional. Recommended screening guidelines call for women in their 20s and 30s (including those with breast implants) to have a breast exam every three years. After age 40, women should have a clinical breast exam every year.
  • Getting a regular screening mammogram, even though implants make it harder to see certain parts of the breast and special x-rays may need to be taken. Recommendations from the American Cancer Society (ACS) state that women at average risk of breast cancer (no personal history) who are between 40 and 44 years have the option of a yearly mammogram. ACS further encourages women aged 45-54 to get an annual mammogram and says those over age 55 can switch to a mammogram every two years.
  • Getting an MRI scan three years after surgery with silicone gel-filled implants and then getting MRI scans about every two years to check for silent rupture. Silent rupture occurs when a breast implant ruptures and leaks, trapping the silicone gel in the capsule that surrounds the implant. If a silent rupture is identified, the surgeon will perform breast implant removal surgery to remove the implant and the leaking silicone material and may also remove the scar tissue that forms after the placement of a breast implant.

BREAST REDUCTION

Breast Reduction Explained

Also called reduction mammaplasty, a breast reduction is surgery to remove excess breast fat, glandular tissue and skin so the breast size is more in proportion with the body. This is especially important for women with excessively large breasts (macromastia) who experience physical discomfort and emotional distress from the weight of their breasts. However, women who do not have macromastia but are unhappy with the large size of their breasts also undergo breast reduction to improve their self-image and their ability to participate in physical activities.

Candidates for Breast Reduction

Breast reduction is meant for healthy women with macromastia, described as disproportionately heavy breasts on an otherwise average size woman. Other candidates for surgery are women who experience back, neck and shoulder pain caused by the weight of their breasts, who have shoulder indentations from bra straps and/or skin irritation beneath the breast crease, or whose breast size limits their physical activity.

Reduction Procedures

Breast reduction surgery can be performed at any age and is usually done under general anesthesia, either in a hospital or outpatient surgical facility. The procedure usually involves making incisions (cuts) on the breasts, then removing breast tissue, fat and skin to reduce the size of each breast. The next step is to reposition the nipple and the areola. However, there are situations when surgeons combine liposuction and the incision technique or only use liposuction if excess skin is not contributing to the large breast size.

After the surgery, the surgeon may use drainage tubes and then stitch up the breasts and wrap them in a special gauze. Many women wear an elastic bandage or surgical bra to keep swelling down and support the breasts as they heal. Recovery from breast reduction surgery usually takes one to two weeks but it can take months for swelling to go down completely and for surgical scars to fade. The final result is generally permanent — although breast shape and size can change due to factors such as aging and weight gain or loss.

Risks and Safety

Breast reduction surgery has the same risks as any other type of major surgery – bruising, bleeding, infection, slow healing of incisions, and an adverse reaction to anesthesia. Other possible risks 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

If you are considering surgery to change the shape and size of your breasts, it is important to learn all you can about the different options to consider and how to select the plastic surgeon who is best for you. Here is what you need to know to take charge of the decision-making process.

Choosing Your Surgeon

Because every woman's body is unique, you will want to select a surgeon that is qualified, skilled, recommended, supportive of your needs, and specializes in your type of surgery. This requires some research and knowing what to look for.

As a first step, read reviews of surgeons in your area and seek recommendations from friends who have had aesthetic breast surgery. Also, ask your general physician or gynecologist to make referrals. Once you decide on a "short list" of top candidates, schedule a consultation with each potential surgeon so you can ask your questions, discuss your goals and concerns, and learn more about the surgery and your options.

Preparing for the Consultation

Understanding what happens during a breast surgery consultation will help you to make the most of these meetings with potential surgeons.

During the consult, which may take 45 minutes to an hour, the surgeon will review your medical history, examine and measure your breasts, and take photographs. The surgeon will also ask you about your goals for surgery, explain procedure options and the likely results, and address recovery time, possible risks, potential complications, and cost.

To make the most of the consult, the American Board of Cosmetic Surgery (ABCS) created a checklist of ways to plan for the session and what to do when meeting with the surgeon.

  • 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.

Getting Answers

Because there are many factors to consider when choosing the surgeon and type of procedure, the American Society for Plastic Surgeons (ASPS) recommends using these tips to help you select the best surgeon for you:

  • Look for board certification in plastic surgery. Before scheduling a consultation, make sure the surgeon is board certified by the American Board of Plastic Surgery. This means the surgeon graduated from an accredited medical school, completed at least six years of surgical training after medical school (with a minimum of three years of plastic surgery residency training), passed oral and written exams, and performs surgery in accredited, state-licensed, or Medicare-certified surgical facilities. Also, check if the surgeon is a member of ASPS, which requires the surgeon to follow rigorous training and patient safety standards.

  • Ask about the surgeon's experience. When choosing a surgeon, an important factor is the surgeon's experience in the type of procedure you are considering. For this reason, experts recommend asking each surgeon about their track record, including how long he/she has performed aesthetic breast surgery, the number of procedures performed each year, the most common complications, the reoperation rate, and whether the surgeon has been involved in any malpractice suits. Getting everything out in the open is the best way to establish trust, so don't be afraid to ask tough questions.

  • Study the surgeon's style and approach . Specialists in aesthetic breast surgeries customize the procedures based on each woman's situation and needs. During the consultation, ask to review the surgeon's gallery of patient cases and before-and-after photos to get a sampling of his or her work.

  • Check out the facility where the surgery will take place . Because most aesthetic breast procedures take place in an outpatient setting, it is important to make sure the facility meets the highest safety standards. Ask the surgeon if the outpatient surgery center is licensed by the state or is accredited by a leading credentialing body. These include the Joint Commission on Accreditation of Healthcare Organizations, the American Association for Accreditation of Ambulatory Surgery Facilities, and the Accreditation Association for Ambulatory Health Care.

  • Find a surgeon you trust. Finding a surgeon that you connect with and have easy communication with can improve your experience. The right surgeon will understand your goals, encourage open and honest discussions about your concerns, give you honest and straightforward guidance on the best surgical approach, and give you a realistic perspective on timeline for recovery and results you can expect.

Making the Decision

Let's face it: choosing the surgeon and the surgical procedure that is right for you requires asking a lot of questions. To make the discussion easier, HealthyWomen created these lists of questions to ask the surgeon if you are considering breast implant surgery, a breast lift, or breast reduction. Print out a copy to take to your consults.

QUESTIONS TO ASK

Questions to Ask About Having Breast Implant Surgery

To help you make the most informed and intelligent decisions about having breast implant surgery, use this checklist to guide your discussion with the breast surgeon:

Questions About the Surgeon's Training and Performance

  1. Are you certified by the American Board of Plastic Surgery?
  2. How many years of plastic surgery training do you have?
  3. How long have you been performing breast implant surgery?
  4. How many breast implant surgeries do you do a year?
  5. Do you have hospital privileges to perform breast implant surgery? If so, where?
  6. Is your office surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?

Questions About the Surgeon's Past Work

  1. What is the most common complication you encounter with breast implant surgery?
  2. What is your rate of complications, in general, for capsular contraction and infections?
  3. What is your reoperation rate?
  4. What is the most common type of reoperation you perform?
  5. Can I see some patient before-and-after photos?
  6. What are my options if I am dissatisfied with the outcome of the surgery?

Questions About the Surgery

  1. Am I a good candidate for this operation?
  2. Are silicone implants or saline implants better for me?
  3. What surgical technique is recommended for me?
  4. How long do you expect the operation to take?
  5. Will I have general anesthesia, and will a certified anesthesiologist administer it?
  6. Where and how will you perform the procedure?
  7. What are the risks and complications with this procedure?
  8. How long of a recovery period can I expect, including time away from work? What kind of help will I need during my recovery?
  9. What can I do to lower the risk of short-term and long-term complications?
  10. Where will my scar be?

Questions About Expected Outcomes

  1. In your experience, how long will my breast implants last?
  2. Will I have numbness after surgery?
  3. What can I expect my breasts to look like over time? What do I need to do to maintain them?
  4. How will my breast implants feel? Will they change the sensation of my breast skin or nipple?
  5. How will I be able to tell if my breast implant has ruptured or there is a problem with my breast implants?
  6. How easy or difficult is it to remove the implants?
  7. What kind of additional follow-up will I need?
  8. How will aging affect my breasts?
  9. What breast cancer screening is recommended for me?
  10. How often will I need to have my breasts checked for any leaks or other problems?
  11. How long should I anticipate the implant will last?

Questions to Ask About Having a Breast Lift

Like other types of breast surgery, a breast lift is not a one-size-fits all procedure. Discussing your goals and expectations with the breast surgeon and asking about different surgical options will help you make the best decision for you. Use this checklist of questions to guide your decision-making:

Questions About the Surgeon's Training and Performance

  1. Are you certified by the American Board of Plastic Surgery?
  2. How many years of plastic surgery training do you have?
  3. How long have you been performing breast lift surgery?
  4. How many breast lift surgeries do you do a year?
  5. Do you have hospital privileges to perform breast lift surgery? If so, where?
  6. Is your office surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?

Questions About the Surgery

  1. Am I a good candidate for a breast lift?
  2. Should I wait until after pregnancy to have a breast lift?
  3. Should I combine a breast lift with breast augmentation surgery?
  4. What surgical technique is recommended for me? How long will the operation take?
  5. Which incision technique would be most effective in my case?
  6. Will I have general anesthesia, and will a certified anesthesiologist administer it?
  7. Where and how will you perform the procedure?
  8. What are the risks and complications with this procedure?
  9. How long of a recovery period can I expect, including time away from work? What kind of help will I need during my recovery?
  10. What can I do to lower the risk of short-term and long-term complications?
  11. Where will my scar be?
  12. Can I see some patient before-and-after photos?
  13. What are my options if I am dissatisfied with the outcome of the surgery?

Questions About Expected Outcomes

  1. How much pain or scarring will I experience following surgery?
  2. What can I expect my breasts to look like over time?
  3. How can I expect to look after pregnancy?
  4. Will a breast lift affect my ability to breastfeed in the future?
  5. How long can I expect results to last?
  6. What kind of additional follow-up will I need?

Questions to Ask About Having a Breast Reduction

Because breast reduction surgery is tailored to each woman's individual needs, having an honest discussion with the breast surgeon about the procedure will help you to understand what is involved and what to expect. Use this list of questions during your consultation to choose the surgeon and best procedure for you:

Questions About the Surgeon's Training and Performance

  1. Are you certified by the American Board of Plastic Surgery?
  2. How many years of plastic surgery training do you have?
  3. How long have you been performing breast reduction surgery?
  4. How many breast reduction surgeries do you do a year?
  5. Do you have hospital privileges to perform breast reduction surgery? If so, where?
  6. Is your office surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?

Questions About the Surgery

  1. Am I a good candidate for breast reduction?
  2. What kind of breast reduction is right for me?
  3. Are there any alternatives to consider?
  4. What is involved in the surgery? How long will the operation take?
  5. Will I have general anesthesia, and will a certified anesthesiologist administer it?
  6. Where and how will you perform the procedure?
  7. What are the risks and complications with this procedure?
  8. What kind of precautions should I take before the surgery and during recovery?
  9. How long of a recovery period can I expect, including time away from work? What kind of help will I need during my recovery?
  10. What can I do to lower the risk of short-term and long-term complications?
  11. Will I have scars? Where?
  12. Can I see some patient before-and-after photos?
  13. What are my options if I am dissatisfied with the outcome of the surgery?

Questions About Expected Outcomes

  1. How much pain or scarring will I experience following surgery?
  2. What will happen to my nipples after surgery?
  3. How many cup sizes can I go down with breast reduction surgery?
  4. Does a breast reduction lift my breasts too?
  5. How long will it take for my breasts to feel normal?
  6. Will I be able to breastfeed?
  7. What can I expect my breasts to look like over time?
  8. How can I expect to look after pregnancy?
  9. Will a breast reduction help reduce my back or neck problems?
  10. How are breast reduction complications handled?
  11. What kind of additional follow-up will I need?

Questions to Ask About Financial Issues

Cost is an important question for women considering breast surgery. The amount depends on the location, surgeon, type of procedure, and type of implant (if used) as well as fees for anesthesia, surgical facility costs, and post-operative medications. Typically, health insurance does not cover cosmetic procedures, like breast augmentation, but health plans will cover surgeries that are considered "medically necessary," such as breast reconstruction and some breast reductions.

To help you have a candid conversation with the surgeon about the surgery costs, here are questions to guide the discussion:

Questions About Surgical Costs

  1. What is the cost of the surgical consult?
  2. If I choose you as my surgeon, will the consult fee be waived?
  3. How much will the surgery cost?
  4. Do you expect full payment upfront?
  5. What is included in the surgical fee? What is not covered?
  6. Are there any other costs I should know about? For lab work, postoperative checkups, additional medications?
  7. How much is the surgical deposit fee? When will I have to pay this?
  8. How much is the cost of anesthesia? Do I pay this separately?
  9. What is the difference in cost between having the surgery in your office versus a hospital?
  10. If I change my mind and cancel the surgery, will my money be refunded?
  11. If I am not satisfied and need revision surgery, is that included in the initial fee?
  12. Is implant removal included in the initial fee?

SUPPORT AND COMMUNITY

Becoming Your Best Self

According to the World Health Organization (WHO), patient empowerment is "a process through which people gain greater control over the decisions and actions affecting their health." This process is especially important for women considering breast surgery because being empowered prepares you to seek out information, make informed discussions and be involved in your care.

What is necessary to be empowered about breast surgery? Research shows that those who are empowered:

  • do online research
  • ask a lot of questions
  • are in contact with other patients
  • access and review their own health data (like electronic health records)

Applying these actions to decisions about breast surgery, being proactive and ready to ask questions leads to having defined goals and realistic expectations, better interactions with the surgical team, and a better chance of satisfaction with the surgical outcome.

Whether you are just beginning to think about having a surgical breast procedure, are preparing for consultations with potential breast surgeons, or are about to have surgery, HealthyWomen has assembled links to evidence-based information from leading medical societies and breast health organizations so you will have the resources you need. Knowledge is power and the way to become your best self.

  • The Aesthetic Society: Professional organization of board-certified plastic surgeons who are solely dedicated to the art, science, and safe practice of aesthetic surgery and cosmetic medicine of the face and body. Their mission includes medical education, public education and patient advocacy.
  • American Society of Plastic Surgeons: The largest plastic surgery specialty organization in the world; advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.
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References

  1. American Society of Plastic Surgeons. Breast Life, What Is Breast Lift Surgery? Accessible at: https://www.plasticsurgery.org/cosmetic-procedures/breast-lift
  2. American Society of Plastic Surgeons. 2018 Plastic Surgery Statistics Report. Accessible at: https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf
  3. American Society of Plastic Surgeons. Combining a Breast lift with breast implants. December 5, 2017. Accessible at: https://www.plasticsurgery.org/news/blog/combining-a-breast-lift-with-breast-implants
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