To treat the problems associated with overly large bust size, plastic surgeons use reduction mammaplasty which can trim off the excess fats, skin, and tissue.  If necessary, this is performed in conjunction with liposuction to further reduce the breast size by eliminating the extra fatty tissues.

In cosmetic and reconstructive plastic surgery, the most common breast reduction techniques are the anchor incision and its modified versions, the lollipop and donut incisions which are ideal for women with smaller breasts and/or moderate ptosis (sagging).

Women with inordinately large breasts with severe ptosis will benefit more with the anchor-shaped incision which is the most invasive technique as it involves excising the extra skin and  and tissue around the areola, across the breast crease, and the vertical area between the nipple and the crease.

While this approach provides a dramatic outcome, this is too extensive for women with smaller breasts and those with minimal to moderate ptosis.  For these patients, plastic surgery specialists will most likely recommend a minimally invasive approach which also provides a great result minus the excessive scarring.

For women with large bust and moderate to minimal ptosis, and patients with medium-sized breasts and severe sagging, the lollipop incision is the best option.  This technique also uses the same incision sites found in the anchor method, minus the one across the breast crease which is the area that takes the longest time to heal.  For this reason, women can expect faster recovery and one less scar.

Another less invasive technique in breast reduction is the donut incision which is performed by excising the tissue around the areola.  Meanwhile, the scars are well-hidden along the edge of the skin and areola which makes this technique appealing to many patients.

But to fully enjoy the benefits of donut incision, many plastic surgeons believe that patients should have a smaller bust with minimal ptosis.  On the other hand, this approach is not enough to address larger breasts particularly with severe sagging.

Some doctors in plastic surgery complement the donut incision with breast implants in order to correct a more pronounced sagging.  But since the weight of these materials may further exacerbate the ongoing ptosis, they always place these under the chest muscles to make sure that a thicker wall of tissue and skin can provide a reliable support.

For example, otoplasty which is a plastic surgery used to pin back the ears can be performed on patients as young as five.  Ideally, this procedure is conducted on children and teenagers because their tissue is easier to work with compared to adults.  But still, some patients choose to have this procedure in later years.

In case the ears of a child are extremely deformed, his parents can decide on his behalf.  But in the situation of a mild aesthetic problem, most plastic surgeons believe that it is better for parents to wait for their kids to ask for any medical intervention since not all them are bothered with their appearance.

To know if a teenager is a good candidate for plastic surgery, doctors not just perform physical examination (to determine the health status) but also discussion to explain the benefit and limitations of a certain procedure.  It is important to note that a good candidate should have realistic goals and expectations which can determine if he will be satisfied with the result.

During the discussion, plastic surgeons will also examine if their teenage patients have enough maturity that will help them cope with the temporary discomfort and downtime after a surgical procedure.  In general, cosmetic surgery is not recommended for patients who have erratic behavior, extreme mood swings, mental illness, and clinical depression.

Aside from having a stable mental and emotional health, teenage patients should also reach a certain age before they can receive a procedure, especially if performed for aesthetic reasons such as breast augmentation and breast reduction; however, the latter is sometimes conducted on women younger than 18 who are experiencing limited physical activities and discomfort because of their large, heavy busts.

If this procedure is performed below the age limit, patients may need a revision rhinoplasty.  However, most plastic surgeons do not follow this age requirement if the surgery is going to be performed as a way to reconstruct the nose after an injury or treat breathing problems due to abnormal growth and birth defects.

And since the implants can create more projection and volume, breast lift combined with these materials is also ideal for women who want to achieve a more noticeable cleavage.

To date, this approach is increasingly becoming popular among women who want to raise and increase the size of their sagging breasts.  But to fully enjoy the benefits of breast lift with implants, the bust size should not be too large and the ptosis should not be too severe.

Most cosmetic plastic surgeons perform this procedure through the use of an incision around the areola which is the pigmented part of the skin; in this way, they can excise the extra skin before they can insert the breast implants.  However, this excision technique may not be enough for women with a more pronounced ptosis which is why doctors may create a second incision that travels from the areola down to the breast crease.

After removing the excess skin around the incisions, doctors will then insert the breast implants.  Many of them will most likely recommend the silicone implant rather than the saline version to achieve a more natural outcome, something which is possible because it uses a cohesive gel filling designed to simulate the “feel” of a real tissue.

The average weight of implants is about 12oz or 350 which may aggravate the ongoing breast ptosis.  Fortunately, plastic surgeons can address this concern by simply placing the synthetic materials under the chest muscle instead above it so that a thicker amount of tissue and skin can support their weight.

Aside from providing a “bra-like” support, doctors in US plastic surgery also believe that the submuscular implant placement also prevents rippling which is a common concern of thin women with limited glandular skin and tissue, reduces the risk of capsular contracture, and creates a more natural result.

Meanwhile, some women are concerned that combining breast lift with implants may result to longer surgical period which means higher risk of complications and also prolonged downtime.  But according to plastic surgeons, the length of recovery and operation of this approach is almost the same with breast lift or breast augmentation when performed alone.

Contrary to popular belief, sagging breasts not just occur among large-busted, older women.  Some individuals with smaller breasts also have this aesthetic problem caused by major weight loss, several pregnancies, or just simply because of hereditary predisposition.

In US plastic surgery, most doctors prefer the anchor-shaped incision when dealing with large-busted women who have severe sagging.  As its name suggests, this technique involves a set of excisions that resembles a nautical anchor—one around the perimeter of the areola, another incision that starts from the areola to the breast crease, and one more that covers the entire breast fold.

Through the incisions, doctors can lift and reshape the underlying tissue in order to improve the breast contour and firmness, and then reposition the areola and nipple to a higher place without completely removing them from their original blood supply and nerve to preserve the sensation in the area.

If needed, cosmetic plastic surgeons will also reduce the size of an enlarged areola by excising the skin around its perimeter.

To compensate for the loss of elasticity, the excess breast skin is carefully removed and the sutures are layered deep within the tissue in order to support the newly shaped bust.  Once the necessary changes are completed, doctors will close the surgical wounds using skin adhesives, surgical tape, and/or sutures.

While the anchor-shaped incision provides a dramatic result, this approach is viewed as too extensive for small- to medium-busted women who have less sagging.  With this consideration, plastic surgery specialists will likely use a new breast lift techniques which involve fewer incisions which means faster recovery and shorter scars.

For medium-sized breasts with severe sagging and large bust with moderate drooping, most plastic surgeons recommend the lollipop lift which uses the same incision sites found in the anchor lift minus the one that covers the entire breast crease—the area which typically takes the longest time to heal; for this reason, patients can expect faster recovery.

Another minimally invasive technique designed for women with smaller breasts is the doughnut lift which only uses one incision around the areola.  And according to plastic surgeons, this approach is best complemented with implants to address a more pronounced sagging and to make the breasts appear fuller.

However, some doctors in cosmetic plastic surgery also use this procedure on men who have enlarged breasts due to the excess fats and tissue, a condition which is medically referred as gynecomastia.

Breast Reduction for Women

Nowadays, most doctors use the inverted T incision pattern in treating women with extremely large and heavy breasts.  With this approach, they place the excisions around the areola, horizontally across the breast crease, and vertically from the areola to the crease.

Through the excisions, doctors can reshape, reduce, and manipulate the breast tissue and then place the areola to a higher position without completely separating this from its blood and nerve supply.  But occasionally, employing the free nipple graft (completely removing it from its original site) is a better choice especially when treating inordinately large bust, although this approach has a higher risk of permanent numbness or reduced sensation in the areola.

Meanwhile, many cosmetic plastic surgeons do not recommend this procedure for women who are planning to get pregnant since it may affect their ability to breastfeed.

Breast Reduction for Men

Gynecomastia is a condition in which the male breasts become enlarged due to the excess tissue and fat.  To treat this aesthetic problem, many plastic surgeons prefer the use of excision technique which may be complemented with liposuction.

If gynecomastia surgery will include liposuction, most plastic surgeons perform this procedure first instead of the excision technique.  This is done by making several small incisions under the armpit or/and along the breast crease where they can insert a fat suctioning probe designed to destroy and dislodge the fatty tissues.

After removing the excess fats, the excision technique will follow. This is performed by creating an incision around the perimeter of the areola and another one that travels from the breast crease to the area above the nipple (using a diamond- or U-shaped incision pattern).  In this way, doctors can trim the excess skin and fats, manipulate the tissue, and reduce the size of an enlarge areola.

In general, plastic surgeons do not recommend surgery for pubescent boys with enlarged breasts since the condition may disappear on its own after their hormonal levels normalize.

In some cases, plastic surgeons also use this procedure to reconstruct the breasts after mastectomy or tumor removal, an invasive procedure performed on some cancer patients to prevent the spread of the disease.

As with any plastic surgery, breast augmentation involves incisions where doctors can insert the saline- or silicone-filled implants.  Today, there are four incision sites patients can choose and these include the breast crease, underarm, and areola, and navel which is the most complex and difficult to use.

Perhaps the most popular incision site is the breast crease since it provides doctors with greater control and allows them to work close to the breasts, however, patients should consider that this surgical technique has a high risk of visible scarring, although this can be reduced by choosing board-certified doctors.

For women who are suffering from slight to moderate sagging in the breasts and want to increase their bust size, most plastic surgery specialists recommend the areola incision pattern so there will be no additional excision.

If the breast lift and augmentation surgery are performed at the same time, doctors remove the excess skin around the areola and then insert the implants.

To prevent or at least postpone sagging in the future, plastic surgeons place the implants under the muscle instead behind the tissue.  With this placement technique, more amounts of glandular tissue and skin can support the weight of the synthetic materials.

Meanwhile, the underarm and navel incision sites are usually the top choice of women who do not want to have scars in their breasts.  But since plastic surgeons work farther away from the bust when using these techniques, patients with a pre-existing aesthetic problem (e.g., asymmetrical appearance and bottoming-out) may not be a good candidate for these surgical methods.

The navel incision is considered as the most complex surgical technique that only a handful of doctors in the US can perform this procedure.  In this plastic surgery approach, doctors create a small incision along the rim of the belly button where they can insert two empty saline implants through the use of endoscope or a small probe with a camera attached to a monitor.  Once the synthetic materials are secured in the pocket, they will fill these with a sterile saltwater using a long tube.

In the traditional breast lift approach, doctors create three separate incisions that resemble an anchor; it travels around the circumference of the areola, another vertical cut starting from the nipple to the breast crease, and a horizontal one that covers the entire crease.

But during donut mastopexy, plastic surgeons only use the incision around the perimeter of the areola, allowing them to remove the excess skin and manipulate the tissue surrounding this area and place the nipple to a higher position.  If necessary, the size of an enlarged areola will be reduced to further improve the breast’s appearance.

Because this plastic surgery procedure only uses one incision site, most patients can expect a relatively faster recovery compared to the traditional breast lift technique.  Additional advantages include unnoticeable scar, less post-operative pain and discomfort, and less risk of complications.

Despite the countless advantages of the donut lift, plastic surgeons do not conduct this to large-busted patients with a severe sagging because it only involves a limited amount of tissue and skin.  In general, only women with small to medium breasts that have a mild to moderate drooping can benefit from this technique.

As with any breast lift technique, the donut lift does not guarantee a lifetime result due to the natural effects of aging and gravity, although majority of small-breasted women can maintain it for many years as long as they will avoid pregnancy and significant weight fluctuation which can weaken the tissue and skin.  It can also be helpful if the patients will always wear a good-fitting bra that provides a great support.

Some plastic surgeons complement this procedure with breast implant surgery particularly for patients who want to increase their bust size and/or achieve a fuller upper pole to create cleavage.  Combining these two plastic surgery procedures may also correct a more pronounced sagging as long as the implants are placed under the muscles (rather than behind the tissue) so that more tissue and skin can support their weight, thus preventing premature sagging.

As with any cosmetic procedure, the donut lift has some risks such as unnecessary scarring, asymmetrical appearance, and infection.  To be on the safe side, patients should choose a board-certified doctor who has an extensive experience with this particular technique.

Meanwhile, most male patients who seek liposuction want to reduce the size of their overdeveloped breasts.  It is important to note that the fats in this area are more fibrous which makes them harder to dislodge and remove from the body.

To gently and effectively remove the fibrous fats in the male breasts, plastic surgeons administer the tumescent solution directly to the area so the fatty deposits will become swollen and firmer.  And because the fluid already contains lidocaine which is a type of local anesthesia, liposuction nowadays no longer involves the use of heavy intravenous sedation and general anesthesia which may increase the risk of complications as they affect the entire body.

Once the solution reaches the fatty areas, plastic surgeons will then create several tiny, round incisions (about 1 to 2mm) where they can insert a cannula which is a suctioning device.  As much as possible, they place the incisions along the breast crease and near the armpit so the scars will not be apparent.

In order to dislodge and remove the fats from the tissues, doctors move the cannula back and forth, although some of them prefer the motorized version which produces accurate, tiny vibrations.  Some experts have claimed that this new instrument can remove 25 to 30 percent more fats than manual liposuction.

While liposuction is usually enough to decrease the size of male breasts, this may not be the case if the enlargement is primarily caused by the excess, loose tissues.  If this were the problem, doctors would rather recommend an excision technique.

For male patients with enlarged breasts due to excess fats and tissue, liposuction is commonly performed several months prior to the excision technique in order to reduce the surgical trauma.

Once the excess, bulging fats have been removed, plastic surgeons will administer an excision technique in which they will trim off the loose skin and tissue in the male breasts.  As much as possible, they will place the incisions along the breast crease, around the edge of areola, and near the armpit so the scars will not be noticeable.

If liposuction is performed as a stand-alone procedure, patients can expect a relatively short and convenient recovery.  However, this is not the case in the excision technique, with or without fat removal surgery, in which the healing period is longer and involves more pain.

Because of the physical changes brought by pregnancy and childbirth, most women will end up having a sagging abdomen due to skin and tissue laxity.  While this problem may be treated with exercise and diet, there are some cases in which the only effective solution is plastic surgery through a procedure called abdominoplasty or tummy tuck.

In this procedure, plastic surgeons create an incision near or along the pubic hairline that will allow them to remove the excess skin and tissues and reshape the muscles which have become separated due to pregnancy.  The length of the incision greatly depends on the severity of the excess tissues, although the general rule is that patients who need the most correction will need a hipbone-to-hipbone incision while those who have minimal droopiness will benefit more with a shorter cut.

In some cases, tummy tuck surgery can also remove or at least reduce the appearance of stretch marks in the abdominal area.

Another popular “mommy makeover” procedure is breast augmentation in which plastic surgeons use silicone or saline implants to increase the bust size, improve a slightly sagging breast, and make this appear fuller.

In this plastic surgery procedure, doctors make incisions below the breast crease, around the circumference of the areola, in the armpit, or within the navel where they can insert the implants.  After the materials have been secured inside the breast pocket, surgeons will then close the incisions using sutures and put compression garments around the chest of their patients.

To prevent or at least postpone sagginess, plastic surgeons generally prefer the under-the-muscle implant placement which provides a reliable bra-like support to the implants.  In addition, this technique creates a gentle slope which makes the breasts appear more natural.

However, breast implant surgery is not the right approach when dealing with moderate to severe sagging of the breasts.  In this problem, breast lift surgery is the best way to correct the drooping bust caused by the skin and tissues becoming less elastic after breastfeeding.

For women who want to have “mommy makeover” plastic surgery, they should postpone this if they are considering having children in later years since pregnancy, childbirth, and breastfeeding will have an effect to the result of the procedure.

To correct breast ptosis, plastic surgeons use breast lift which typically involves three separate incisions that form an anchor-shaped scar which will enable them to remove the extra skin and fats and manipulate the underlying tissues.  (See the incision pattern below.)

In some cases, this procedure is performed in conjunction with breast implants to further create volume especially in the medial and upper poles of the bust that will lead to a more prominent cleavage.

If breast implants are combined with breast lift, plastic surgeons would only use the areola incision instead of the extensive anchor lift; as a result, patients can also expect less scars.

As with any cosmetic surgery, breast lift involves risk of complications which can be reduced by following the pre-operative guidelines that typically include avoiding “blood-thinning” medications, smoking, alcohol, and herbal supplements.

According to several studies, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can inhibit blood clotting and healing which means that patients can experience excessive bleeding during and after their surgery.  For this reason, most plastic surgeons recommend to stop these medications at least two weeks prior to the procedure and during the recovery.

Certain herbal supplements such as those containing green tea, vitamin E, and gingko biloba have also been found to inhibit blood clotting.  Just to be on the safe side, patients should tell their plastic surgeons about all the medications and supplements they are taking.

For smokers, they will most likely be advised to stop the bad habit at least two to three weeks prior to the surgery and during the recovery.  According to several studies, skin necrosis or death of skin tissue is 1,500 times more likely to occur among smokers than non-smokers.

It is important to note that skin necrosis is associated with prolonged healing and unnecessary scarring.  And because of these risks, plastic surgeons conduct random blood testing prior to surgery to determine the presence of nicotine in the blood.

Meanwhile, preparing for breast lift also means planning for one’s recovery.  This will include assigning a companion for the first two days after the surgery, securing supplies needed during the recovery, and securing all the medications and special garments that will be used during the healing period.