These are the types of plastic surgery performed to aesthetically improve the breasts:

• Breast lift

Due to pregnancy and natural effects of aging, the breasts may drop due to their own weight and gravity.  To treat this problem, plastic surgeons use breast lift which often involves an anchor-shaped incision—the first one is around the areola, the second travels downward from the areola to the breast fold, and the third covers the entire crease of the bust.

While the anchor lift is very effective in removing the excess skin and manipulating the underlying muscles, this approach is relatively extensive for women with small- to medium-sized breasts.  With this consideration, plastic surgery specialists have developed modified breast lift techniques which are less invasive than the traditional approach.

In some cases, breast lift is combined with breast implant surgery if a patient wants to have a more prominent cleavage.

• Breast augmentation

Traditionally, this plastic surgery procedure is performed using saline- or silicone-filled implants to increase the bust size and create a good cleavage by making the upper poles appear fuller and rounder.

But for patients who only want to slightly increase their breast size (or less than a cup), fat grafting is usually considered as a better option.  In this procedure, plastic surgeons collect fats from the abdomen (or any area where there is a significant amount of fatty deposits) and then transfer these to the bust.

• Breast reduction

For women with an extremely large bust, they can have breast reduction surgery which uses an anchor-shaped incision, allowing plastic surgeons to remove the extra skin and fats and manipulate the surrounding tissues.

In some cases, breast reduction is not only treated as a cosmetic procedure but also as a way to address the physical symptoms such as back problem, chronic pain in the shoulder and neck, skin irritation in the breast crease, and difficulty to engage in sports and other rigorous activities.

If breast reduction is used to treat the physical symptoms stated above, it is important to note that it may be covered by some insurance providers.

Meanwhile, this procedure may also involve areola reduction to make it appear more natural to the breasts.

Implant-related problems such as rupture in the shell are the most common reasons why doctors perform revision breast implant plastic surgery.  Fortunately, most US manufacturers provide lifetime warranty on their products and may even offer some form of coverage to other expenses related to surgery.

To detect leaks in silicone-filled implants, doctors recommend MRI screening three years after breast augmentation and subsequently every two years.  However, this is not a requirement for patients with saline implants which can immediately inflate within four hours after the shell breaks.

Aside from rupture in the shell, another common implant-related problem is wrinkling in which patients with limited amount of breast skin and tissue are at higher risk compared to large-framed women who usually have a thicker glandular tissue.

It is interesting to note that the chance of implant wrinkling can be easily reduced by placing the material under the breast muscles instead of behind the tissue.  This is why most board-certified plastic surgeons recommend and use this implant placement technique which is also noted for giving a natural result and preventing sagginess in later years.

Meanwhile, revision breast implant surgery usually involves replacing it with a new one.  This is because removing the implants without replacing them may result to unnatural appearance since the tissue have already been stretched, although this approach may be the best option for women who want to permanently remove the synthetic materials due to medical or personal reasons.

For patients who do not want to replace their implants, plastic surgeons will most likely perform a more extensive procedure in order to address the overstretched tissue.

Many plastic surgery experts believe that removing the implants “en bloc” is the most ideal approach.  This means that the entire material and the scar tissue capsule around it are removed together; in this way, doctors can make sure that any silicone that may have leaked from a rupture shell is removed.

However, this approach is more difficult than removing just the breast implants.

It is important to note that removing the implants is more complicated than putting them, especially if there is a leak in the shell.  For this reason, patients should consult with plastic surgeons who have an extensive experience in performing not just “implantation” but also “extraction.”

In general, revision breast implant is performed to correct aesthetic- and implant-related problems such as leak, bottoming out, and capsular contracture—a painful condition in which the scar tissue attaches itself to the shell, which then distorts the appearance of the breasts.

But still, most women who had a revision breast augmentation surgery were unsatisfied with the size of their breasts.  Some of them thought that they have gone too big or too small.  (Pamela Anderson has undergone several revisions for her bust.)

For women who want to further increase their breast size, most cosmetic plastic surgeons consider the amount of breast skin and tissue, overall body frame (small- vs large-framed structure), and chest width in order to avoid the risks and complications related to having sizes that are too large for the body and tissue to accommodate.

It is important to note that petite women who usually have limited breast skin and tissue are at higher risk of developing complications—such as wrinkling, more post-operative pain, and bottoming out—compared to large-framed patients.

Meanwhile, most cosmetic surgeons believe that it is always easier to replace smaller implants with bigger ones than the other way around as long as there is enough skin and tissue that will cover the biocompatible materials.

In contrast, replacing the implants with smaller ones usually requires a more extensive surgery because the tissue and skin have been stretched.  For such reason, internal suturing or capsulorrhaphy will most likely be needed to tighten the capsule surrounding the implants and also “lift” the tissue and skin.

If needed, some doctors in LA plastic surgery perform breast lift in conjunction with revision breast augmentation particularly for patients whose breast tissue and skin turned saggy due to aging, weight loss, physical effects of childbearing, and natural changes of the body.

These are the most common breast problems and their corresponding solution, according to LA plastic surgeons:

• Drooping breasts

Due to aging, pregnancy, and major weight loss, some women develop drooping breasts with nipples pointing downwards.  To treat this problem, plastic surgery experts use breast lift which involves removing the excess skin, manipulating the underlying muscles, and raising the bust to a higher position.  In some cases, they complement this surgery with implants to further make the breast, particularly the upper pole, appear fuller.

• “Swooping” breasts

While the breasts do not have a pronounced droopiness, they bend inward above the areola resulting to a “swooping” appearance.  To treat this aesthetic problem, plastic surgeons use breast implant surgery to improve the contour of the bust.

• Smaller breasts

Due to genetic predisposition, some women have extremely small breasts almost comparable to men’s.  Fortunately, breast augmentation through the use of saline or silicone implants can increase their bust size.

For women who do not want to use synthetic materials to increase their breast size, they can opt for fat grafting, a procedure in which doctors collect fats from their tummy (or areas where fats tend to accumulate), which are purified to separate the blood and tissue and then re-injected to the breasts.

However, fat grafting can only increase the breast with less than a cup, which means that it is not ideal for women who want to significantly augment their bust.

• Tuberous-shaped breasts

In this problem, the breasts have a prominent outward projection from the chest wall and are very narrow at the base, thus resulting to a tubular shape.  This condition usually happens on women who have small breasts with noticeable droopiness due to skin and tissue laxity.

In LA plastic surgery, most doctors treat this problem through breast implant surgery that is usually combined with breast lift especially for women with extremely sagging bust.

• Enlarged areola

In some cases, women who need breast lift or breast reduction will also benefit from areola reduction surgery to further create a more natural-looking appearance.  Fortunately, combining this procedure with other breast surgeries does not require additional incisions because they usually have the same surgical site.

Most plastic surgeons agree that the wider the space between the breasts, the harder it is to achieve a more prominent cleavage.  Fortunately, women with this anatomical feature can at least achieve more fullness in the upper poles if they will use the round-shaped implants and not the teardrop version which lacks projection by volume in the upper area of the breast.

While bra sizes are traditionally measured by A, B, C, and D cup, breast implants are not.  This is because bra cups usually have different standards depending on each company.  With this consideration, the implant sizes are differentiated using cubic centimeters (cc) which can range from 120cc to 800cc.  (Some guidelines: 60cc is equal to 2 ounces and it usually takes a difference of 100cc before patients can see a noticeable change).

To help patients decide on the breast size they want to achieve after their plastic surgery, most doctors recommend the “rice” test which involves filling a knee-high stocking with uncooked rice.  A good way to start this experiment is by filling the stocking with 300cc (equivalent to 10 ounces) of rice and then place this inside the unpadded bra.  They can add or remove a small amount of rice to try on different sizes.

While breast implant surgery is designed to increase the bust size, there are certain factors which must be considered.  For example, petite women who usually have minimal tissue and skin are at higher risk of wrinkling and rippling if they go for extremely large implants; for this reason, a good plastic surgeon will not push his patients’ body by introducing sizes that are too large.

On the other hand, plastic surgeons said the risks are not as high for large-framed women who usually have thicker tissue and skin that can serve as a natural padding for the implants.

To date, there are different types of breast implants in terms of sizes, shapes (round vs teardrop), profile or projection (low, moderate, and high), filling (saline vs silicone), and shell (smooth vs textured) to accommodate the anatomical features of each patient and meet her expectations, according to plastic surgery specialists.

According to plastic surgeons, “bottoming out” is one of the most common reasons for revision breast implant.  This condition happens when the synthetic material travels south and results to unsightly, drooping breasts.  (See picture below.)

There are certain factors that can increase a patient’s risk to this complication, including over-dissection of the implant pocket during the initial surgery.  This pocket, in which the implant is placed, should be not be too big to the extent that the material can travel freely.

Bottoming out also happens if the implants are too big and heavy for the skin and breast tissue to accommodate.  With this consideration, plastic surgeons do not recommend larger sizes for petite women who usually have limited skin and tissue in their bust.

Some plastic surgery experts also attributed this complication with the use of above-the-muscle implant placement on thinner women or those who have limited skin and tissue.  To minimize such risk, the under-the-muscle placement is the most recommended so there will be more breast tissue and skin to support the implants and serve as a padding that will cover the synthetic materials.

Currently, there are different techniques to address implant bottoming out including the use of internal sutures to reduce the size of the breast pockets and push the implants to a higher place and reposition the areola in the center of the breast mound.  But instead of using sutures, some plastic surgeons use a flap of tissue derived from the inside of the pocket to reduce the capsule.

While the said approach can correct bottoming out, most doctors stay away from this since the stitches may cause additional scarring.

Fortunately, there is another option to treat this problem.  By using tissue substitutes such as Strattice and Alloderm, there will be a structural brace to hold the breasts up and support the implants.  This approach is ideal for patients who do not have enough tissue in their breasts.

Certain cases of bottoming out can be addressed by breast lift (or mastopexy) combined with skin removal along the breast crease.  And if the problem is also caused by implants that are too large, plastic surgery specialists will most likely replace them with a smaller size to prevent this complication from happening again.

For drooping breasts with nipples pointing downwards, doctors in plastic surgery use mastopexy or what is more commonly referred as breast lift.  In this procedure, they usually create incisions around the areola, across the crease of the breast, and vertically from the areola to the fold that will allow them to remove the excess skin, raise the bust to a higher position, and reshape the tissue.

In certain cases, this approach is too invasive for some women, particularly those with smaller breasts that have minimal to moderate sagginess.  For this reason, plastic surgeons use modified breast lift techniques which remove the horizontal incision across the breast fold or even the vertical cut.

While breast lift can raise the bust, it does not create fullness in the upper poles.  With this, some women ask for a breast implant surgery to complement the procedure, especially those who want to achieve a more prominent cleavage.

For women who have “swooping breasts” (they bend inward above the areola) and those with “tuberous” breasts (they have a very narrow base and have a prominent projection), most experts in plastic surgery agree that breast implant surgery is usually the best approach to address these aesthetic problems.  If needed, the implant surgery is complemented with breast lift to further improve the contour.

But still, breast implant is more popular known as a way to increase the size of smaller breasts.  To date, most plastic surgeons prefer using silicone or saline implants due to their high tissue compatibility and relative safety to a significant number of patients.

While there are many women wanting to have larger breasts, some big-busted individuals would like to reduce their size to eliminate the physical symptoms associated with extremely large breasts which usually include bad posture, difficulty to engage in sports and rigorous activities, bad posture, and chronic pain in the shoulder, neck, and back.

To reduce the size of large breasts, doctors in LA plastic surgery perform reduction mammaplasty which involves the same incision sites used in the anchor incision breast lift.  If necessary, they complement this procedure with liposuction to remove the excess fats in the bust.

In some cases, reduction mammaplasty involves minimizing the size of an enlarged areola and repositioning this to a higher position.

In the US, only the saline- and silicone-filled implants have been approved by the Food and Drug Administration due to the proliferation of clinical data showing their safety to a significant number of women.  However, patients should remember that breasts implants, while designed to stay up to 25 years inside the body without any problem, may not last a lifetime which means that they will most likely undergo a revision plastic surgery in later years.

For women who want to achieve a more natural result, plastic surgeons generally recommend the silicone-filled implant as it contains a cohesive gel material noted for simulating the movement and feel of a real tissue.  But since it involves more risks compared to the saline, this can only be used on patients 22 years and older.  (See picture below.)

On the other hand, the saline-filled implant, which is allowed to patients aged at least 18 years old, are noted for its safety as it contains a sterile saltwater that can be absorbed by the body without any problem in case of a leak.  And since the solution is immediately absorbed by the tissue just after few hours of leaking, thus resulting to a deflated breast, patients can ask for a revision plastic surgery right away.

However, this is not the case for silicone implants with leaks that may go undetected for years since the cohesive gel stays around the tissue and may even travels to other parts of the body such as in the underarm, lymph nodes, and even organs.  For such reasons, plastic surgeons require women to undergo a regular MRI screening which should be conducted three years after the surgery and subsequently every two years to identify leaks and immediately address the problem.

Both the saline and silicone implants come either in teardrop or round shape.  For women who want to have a prominent cleavage and achieve fullness in the upper poles, most plastic surgeons recommend the round implant.  And because of its symmetrical shape, this type of implant has no risk of becoming distorted due to implant rotation.

Some women think that the round-shaped implants may look unnatural because of their round, augmented look.  For this reason, some doctors recommend the teardrop implants which have a “gentle” slope similarly to the natural shape of breasts.

But since the teardrop implants involve risk of having a distorted breast, these always come with a textured surface to prevent implant rotation.

It is also important that the patients are not smoking or not exposed to second-hand smoke since the nicotine, carbon monoxide, and other chemicals found in the cigarettes can delay the body’s healing ability by interfering with oxygen absorption and diminishing the blood supply from the incision site.  In most cases, delayed healing results to risks of skin necrosis (death of skin tissue that results to unnecessary scarring) and also infection.  (See picture below.)

To reduce the risk of skin necrosis and other complications associated with smoking, most plastic surgeons ask their patients to stop the habit several months before and after the surgery.  Following such advise is critical since a recent study shows that smokers are 1,500 more likely to develop skin necrosis compared to individuals who are not smoking.

Because of the risk of smoking, majority of plastic surgeons are now refusing to operate on smokers, especially those who seek breast surgery, facelift, tummy tuck, and other procedures that require skin to be shifted, unless they are willing to quit the habit well in advance of their plastic surgery.

Aside from being physically fit, a good candidate for breast augmentation surgery should have realistic goals and expectations which can have a significant impact on the satisfaction of patients after the surgery.  It is important to note that with realistic and attainable expectations, this plastic surgery can improve a person’s confidence and body image.

Meanwhile, breast augmentation is usually performed with the use of silicone or saline implants, although fat grafting (using a patient’s own fats to augment the bust) is increasingly becoming a popular alternative for women who want to slightly increase their size (this approach can only increase the bust with less than a “cup”).

With this consideration, breast implant surgery is usually recommended on patients with smaller breasts who want to significantly increase their size.  However, petite women who usually have limited breast tissue and skin may not accommodate larger implants because they are at higher risk of rippling and wrinkling.

While more commonly used to increase the bust size, plastic surgeons also perform breast implant surgery to address asymmetrical appearance (one breast is smaller or sags more than the other), make the breast appear fuller again after weight loss or pregnancy, and reconstruct the breast of post-cancer patients.

However, patients should remember that they will most likely need a revision breast surgery at some point in their lives due to different reasons such as implant deflation, bottoming-out (implant migrating downward), asymmetrical appearance, and not being satisfied with the result.

Most plastic surgeons believe that the most common reason why women choose to have a revision breast surgery is that they are not satisfied with the size (either going too small or too large).  For this reason, it is important for patients to spend several months to think about the size they really want to achieve before their surgery.

For women who want to have larger breasts through a revision surgery, most plastic surgeons consider the overall body frame, amount of skin and tissue, and other factors which may limit the body from having a large-sized implant.

Going from small implants to bigger ones is usually easier compared to replacing large implants with a smaller version.  According to experts in LA plastic surgery, this procedure is usually possible as long as there is enough amount of skin and tissue to cover the implants and the body can accommodate larger breasts.

On the other hand, replacing implants with smaller ones requires a more extensive surgery since the skin and tissue have already been stretched.  For these reasons, LA plastic surgeons usually perform internal suturing (or capsulorrhaphy) to tighten the capsule that surrounds the implants and lift the skin and tissue.

In some cases, doctors in plastic surgery also recommend breast lift to be performed in conjunction with revision breast implant especially to patients whose breast skin and tissue become saggy due to weight loss, several pregnancies, aging, and natural changes of the body.

If breast lift is performed in conjunction with breast implant surgery, doctors usually use the areola technique since both procedures require the same incision site.

Meanwhile, these are the other reasons for revision breast surgery: implant deflation, bottoming out, ruptured shell, asymmetrical appearance, natural changes in the breasts, implant rotation (only happens to teardrop implants), and capsular contracture (a condition in which the capsule around the implants squeezes the materials resulting to a painful, distorted breast).

Instead of replacing the implants with a new one or different size, some patients prefer to permanently remove these biocompatible materials due to personal or medical reasons.