Breast Procedures

Breast surgery is not one operation

Several quite different operations sit under the heading of breast surgery. One patient wants volume. Another is troubled by sagging. A third has both. A fourth wants relief from the back and shoulder pain that too much volume causes.

Choosing the right operation determines most of the result. An operation chosen wrongly will not satisfy the patient even if it is performed flawlessly.

How the decision is made

At examination, these are the things assessed:

• The existing volume of breast tissue and the volume you are hoping for
• The position of the nipple — where it sits relative to the inframammary fold determines the degree of ptosis
• Skin quality and elasticity — pregnancy, breastfeeding and weight change all affect this
• Chest wall and shoulder structure — most asymmetry originates here
• Your expectation — and how far it matches your anatomy

Without this assessment the question “which operation” cannot honestly be answered. Some patients arrive having already decided from what they read online; by the end of the consultation we often agree on a different route.

Three situations seen most often

Volume is adequate but there is sagging. An implant alone is not the answer here; a lift is needed. Placing an implant on its own can make the sagging more obvious.

Volume is low and there is mild sagging. Here a lift and an augmentation are planned together, in a single operation.

Volume is excessive and the complaint is physical. Back pain, shoulder grooving, difficulty exercising. For these patients breast reduction is as much a functional operation as an aesthetic one.

Scars deserve an honest conversation

Breast lift and breast reduction leave scars. This has to be discussed from the outset, because a patient who learns it afterwards feels let down.

The position and length of the scar depend on the technique; it fades with time but does not disappear entirely. In breast augmentation, by contrast, the scar is far more limited.

Exactly what scar to expect from which operation is explained one by one at examination.

Recovery

Most of these operations involve one night in hospital. Swelling and tenderness are expected in the first days, and wearing a supportive bra is part of healing.

Return to desk work is usually within a week; sport and heavy lifting wait until after your check-up. The final shape takes a few months to settle.

Combined procedures after pregnancy — breast and abdomen in a single session — are described on the mummy makeover page.