Cosmetic breast surgery is done to enhance the appearance of the breast. It may be done to increase or decrease size, improve symmetry or reduce sagging. Increasing the breast size is called breast augmentation or breast enhancement. This is most commonly done with breast implants which can be filled with saline (a salt water solution) or silicone gel. Recent reports describe breast enhancement with the patient’s own fat. This is still not widely accepted as safe.
Large breasts can be reduced in size for improved cosmetic appearance or to reduce symptoms. While the cosmetic breast reduction is the same operation as a functional breast reduction, the indications and goals vary greatly. Additionally, insurance companies will often place certain requirements for coverage. This section will address cosmetic breast reduction only.
Breast sagging (or ptosis) can result from childbearing, weight changes or simply from aging. It is defined as the relationship of the nipple and the fullest part of the breast to the fold under the breast (called the inframammary fold). When the nipple descends below the fold, there is sagging or ptosis. Sagging is the result of the loss elasticity of the supportive tissues of the breast. The support is both internal (fibers that run through the breast called Coopers Ligaments) and from the skin (referred to as the skin brassier).
Surgery to improve sagging repositions the nipple and breast tissue above the inframammary fold and tightens the skin. It does not change the characteristics of the poorly elastic support tissue. Changes in the breast are often a result of pregnancy and/or aging. These changes may also include loss of breast volume and thus placement of a breast implant is commonly included in breast lift surgery.
Finally, male breast reduction is included in this section. The vast majority of males will develop breast enlargement at the time of puberty. This enlargement goes away in most males who experience it. A few will not and this may lead to embarrassment in these young men. Surgery to reduce the male breast varies with the size of the reduction and the degree of skin excess. Though this is a common non-pathologic process, patients must be evaluated to rule out medical conditions that can lead to male breast enlargement.