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 There are many reasons why women have plastic surgery performed on their breasts. For some women, their breasts may be too small, for others it may be a need to correct an imbalance or perhaps reconstruct their breasts after a mastectomy.
Whatever your decision, your consideration of any procedure should be based on realistic expectations.
With that in mind, please review the list of several procedures below.
Augmentation mammaplasty is typically performed to enlarge small breasts, underdeveloped breasts or breasts that have decreased in size after a woman has had children. The procedure is accomplished by surgically inserting an implant behind each breast. Both the saline and silicone breast implants are available today for this purpose. These implants are silicone shells filled with saline or salt water or silicone gel, respectively.
 Breast augmentation is often times oversimplified as a procedure. Rather, it entails a fair amount of planning which takes into consideration a multitude of factors including the person's height, weight, body habitus, chest wall measurements, their desired breast size and shape, and selected photographs of their desired breast size and shape. The procedure may be combined with others such as a breast lift. As always, communication between physician and patient is critical.
The physician must weigh and convey other, additional, considerations which include implant location (behind the breast tissue or behind the muscle), implant type (round or teardrop), implant surface (smooth or textured), incision placement (armpit, around the areola or beneath the breast). Each consideration should be individualized to each respective patient.
A modification of the traditional breast augmentation procedure is referred to as the dual plane technique, published extensively in the plastic surgery literature since 2001. The dual plane approach combines the techniques of augmentation both beneath the muscle above and the gland below thereby permitting a more natural "take-off" of the breast while simultaneously allowing for the existing breast envelope to be filled as it exists. The result is a more pleasing aesthetic appearance of the breast oftentimes avoiding the need for an uplift in women with a sagging, or overtly ptotic, breast.
These devices may be utilized for reconstructive purposes such as breast reconstruction following mastectomy, congenital malformations or anomalies, and even those women desiring both uplift and augmentation.
 A breast lift, or mastopexy, is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin's natural elasticity or simply the effects of gravity.
The traditional technique for this procedure entails an incision which encircles the areola continues vertically down the breast and traces the inframammary fold. Once again, communication, planning and proper execution are critical to a successful outcome. Herein, the resultant breast shape and lines of closure should prove to be aesthetically pleasing and not a disappointment. This breast shape must be conical, rounded and not boxy or square. Tension on lines of closure has been shown to frustrate, even thwart, the best efforts to minimize the prominence of incisions. Tension must be avoided when utilizing this technique thereby allowing for resultant lines of closure which are finely linear and relatively inconspicuous.
A different approach to this procedure is referred to as the vertical mammaplasty. This technique was modified by Madeline Lejour, M.D., a Belgian plastic surgeon, in 1989 and introduced to the United States at the national meeting of The American Society of Plastic Surgeons in 1991. The vertical mammaplasty, or Lejour technique as it is often referred, entails an incision around the areola with a vertical limb only. There is no incision beneath the breast mound. This distinguishing feature as well as the creation of a final breast shape which is consistently conical make this technique preferable to the traditional approach described above. Many plastic surgeons do not perform this procedure, however, as there is a relatively steep learning curve and a lack of familiarity with the nuances inherent in this technique could prove disastrous.
For purposes of breast lift, then, there is both the traditional technique as well as the vertical mammaplasty. Herein, the vertical mammaplasty maintains a clear advantage. In a breast lift, excess skin not volume is the focus of the procedure and the vertical mammaplasty, with its use of limited incisions while simultaneously fashioning a beautiful breast shape, reigns supreme.
The procedure can be performed alone or in combination with breast augmentation for added volume.
 Breast reduction is performed to correct large, sagging breasts. Oversized breasts interfere with normal function and physical activity by causing back pain, postural problems, deformities of the back and shoulders, skin rashes under the breasts and breast pain. Though classified as a reconstructive procedure, breast reduction surgery has an important aesthetic component improving the shape of the breasts and enhancing one's overall appearance by making the breasts more proportional to the rest of the body.
The traditional technique for this procedure entails an incision which encircles the areola continues vertically down the breast and traces the inframammary fold. Once again, communication, planning and proper execution are critical to a successful outcome. Herein, final breast size should be anticipated prior to the procedure. Moreover, the resultant breast shape and lines of closure should prove to be aesthetically pleasing and not a disappointment. This breast shape must be conical, rounded and not boxy or square. Tension on lines of closure has been shown to frustrate, even thwart, the best efforts to minimize the prominence of incisions. Tension must be avoided when utilizing this technique thereby allowing for resultant lines of closure which are finely linear and relatively inconspicuous.
A different approach to this procedure is referred to as the vertical mammaplasty. This technique was modified by Madeline Lejour, M.D., a Belgian plastic surgeon, in 1989 and introduced to the United States at the national meeting of The American Society of Plastic Surgeons in 1991. The vertical mammaplasty, or Lejour technique as it is often referred, entails an incision around the areola with a vertical limb only. There is no incision beneath the breast mound. This distinguishing feature as well as the creation of a final breast shape which is consistently conical make this technique preferable to the traditional approach described above. Many plastic surgeons do not perform this procedure, however, as there is a relatively steep learning curve and a lack of familiarity with the nuances inherent in this technique could prove disastrous. In addition, this approach is limited with respect to the amount of breast tissue that can be removed at procedure which typically translates to one cup size.
 Those persons who lose volume and tone postpartum or consequent to weight loss may desire breast enlargement as well as a lift. Whether these procedures are performed at the same time or in tandem remains somewhat controversial. Some surgeons prefer to stage the procedure and perform either the augmentation or uplift first followed by the remaining procedure after a designated period of recovery. The rationale behind this staged approach is that simultaneous augmentation and uplift represents the manipulation of two independent variables during the same surgical sitting which may sacrifice accuracy.
It is the position of this office that accuracy need not be sacrificed should the patient desire simultaneous augmentation and uplift. Herein, the use of a technique referred to as "tailor-tack" helps to ensure such accuracy. During this procedure, the augmentation is traditionally performed first. The operating room table is then brought to a fully upright position wherein temporary sutures are placed to provide for the uplift much the same way that a tailor does when altering a garment. The breast mound is thereby brought into harmony with the underlying implant. Should these temporary sutures prove satisfactory, they are delineated, the uplift is definitively performed and permanent sutures placed.
The "tailor-tack" approach is somewhat time consuming and, as a result, not performed by many surgeons. However, none can dispute its accuracy.
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