Women undergo breast enhancement procedures for a variety of reasons, including dissatisfaction with the natural size or shape of their breasts and changes due to pregnancy, breastfeeding, and the natural aging process. Dr. S. Alex Earle of Pure Plastic Surgery in Miami explains the options and the breast concerns they are designed to address.

According to the American Society of Plastic Surgeons (ASPS), breast surgery accounted for 25 percent of all cosmetic surgical procedures performed in 2017. Breast augmentation was by far the most popular with 300,000 procedures performed, but almost 150,000 women underwent a breast lift and reduction surgery as well. These numbers are no surprise since many women’s self-confidence and sense of femininity are intrinsically linked to the appearance of their breasts—however, it’s important to understand what each procedure is able to achieve.

The concern: The natural size and shape of the breasts
The ideal procedure: Breast augmentation
Breast augmentation uses implants to increase the fullness, firmness, and overall size of small or uneven breasts. Many factors are taken into account when planning breast augmentation, including the patient’s size, build, and natural starting breast appearance, along with their desired outcomes. Implant options include saline or silicone as well as a variety of shapes, projections, and textures. After a thorough consultation and examination, an experienced board-certified plastic surgeon will recommend the ideal implant, position (above or below the pectoral muscle), and incision placement (i.e. in the breast crease, around the nipple, or in the armpit) that will yield the most natural-looking results that align with the patient’s goals.

The concern: Sagging breasts
The ideal procedure: Breast lift
Breast augmentation alone does not address sagging caused by excess skin. Women who experience drooping and volume loss due to pregnancy, breastfeeding, massive weight loss, and the natural aging process generally require a breast lift. This procedure involves removing excess skin and tightening supportive tissue before reshaping the breasts and repositioning the nipple if necessary. It’s important to know that breast lift surgery does not increase breast size, and multiple incisions (and potentially visible scars) may be necessary to achieve the desired outcome.

The concerns: Droopy breasts and loss of volume
The ideal procedure: Breast lift with augmentation
In the event of breast sagging along with a “deflated” appearance, a breast lift with augmentation can restore fullness and improve the overall shape, position, and appearance of the breasts. This combination procedure incorporates breast-lift techniques and augmentation with implants to increase cup size while reshaping the breasts and restoring them to a higher, more aesthetically pleasing position.

The concern: Overly large breasts
The ideal procedure: Breast reduction
Excessively large breasts can cause physical discomfort as well as emotional distress. Many women with breasts that are disproportionate to the body size are self-conscious of their appearance, and often and try to hide their breasts by wearing baggy clothes or avoiding certain social and intimate situations. In these cases, breast reduction can significantly improve quality of life, as well as physical side effects like back pain. Breast reduction surgery involves removing excess fat, skin, and glandular tissue to reshape the breasts, increase their firmness and eliminate sagging. The nipples and areola are usually made smaller to match the new breast size and shape. There are several breast reduction techniques that require incisions around the areola and down to the breast crease, and possibly along the breast crease. The ideal approach for each patient generally depends on the starting size of the breasts, degree of sagging, and desired size reduction.