Introduction Whether you want to use cosmetic surgery to increase or reduce the size of your breasts or to correct breast sagginess, you should know that there are numerous treatment options and operative techniques that you can choose from. In this article, we will discuss breast surgery options that can help improve the appearance of your bust. Breast augmentation Breast augmentation is the surgical procedure performed for breast enlargement in order to harmonize the bust in respect to the silhouette of the patient. This intervention concerns breasts that are too small due to weight loss, pregnancy or hormonal modification (hypotrophy) or breasts that are underdeveloped. Breast augmentation surgery is part of aesthetic surgery but also a restorative surgery, meaning it can be performed to reconstruct the breasts after an accident or a disease. The intervention involves the implantation of breast prostheses which can sometimes be associated with a breast lift surgery (mastopexy). An alternative to breast augmentation by inserting implants is the autologous fat transfer to the breasts. In some cases, fat transfer is associated with breast implant surgery. Indications for breast augmentation In aesthetic surgery, surgical goals and strategies for breast augmentation differ from one patient to another. The curve and the volume are adapted according to the wishes of the patient. The surgery acts on the shape of the breasts and their volume. Depending on the patient’s thoracic morphology, the plastic surgeon will recommend the surgical approach, the location of the implantation pocket, and the most appropriate implant type. A minor breast ptosis can also be corrected with the use of implants. Here are some cases when breast augmentation is indicated: Inadequate development of the mammary gland (hypotrophy) Tuberous breasts or breasts have a tubular form due to a narrowed breast base and an areolar tract (wide and distended areola). The breast augmentation will act on the base of the breast by correcting and repositioning the breast, ascending the breast, and correcting the distension of the skin in the area Reconstruction after mastectomy Breast congenital malformations such as Poland syndrome. Prosthetic breast augmentation is indicated to correct the lack of breast development and is associated with a correction of major pectoral muscle deficiencies Mammary asymmetries Choosing the breast implant type Breast prostheses comes in different sizes, shapes, and contents. The plastic surgeon performs a thorough examination of the breasts: the mammary gland, fat tissue, muscles on the chest and thorax, and the quality of the skin in the area. After also taking into consideration the goals of the patient and the expectations she has from the procedure, he recommends the type of implant best suited for the patient (round or anatomical, silicone or saline) as well as the site of implantation (under the mammary gland or pectoral muscle). The most widely used breast implants consist of a silicone casing containing a highly cohesive silicone gel, which provides a very natural and pleasant feel when touched. In addition to the natural effect felt by palpation, silicone gel prostheses offer the most aesthetic and harmonious result. Scientific studies have proven the safety of silicone gel breast implants; these implants do not cause any malignant disease or autoimmune diseases. The breast implants pre-filled with the saline solution are placed in the implantation pocket when deflated and filled with saline in a second stage, after they are placed inside the breasts. The saline solution does not harm the body if a rupture occurs, but this choice may sometimes involve unsightly waves on the breasts if the skin quality is poor. The duration of a breast augmentation operation with implants doesn’t take longer than one or two hours, depending on the type of implant chosen and the surgical approach. General anesthesia will be used. The results are permanent and can be visible immediately after the surgery in terms of size increase. The final shape and consistency of the breasts can be evaluated three to six months after the surgery when the swelling and bruising subside. Fat transfer to the breasts can also be used to augment size. The breasts are reshaped by injection of autologous fat or the patient’s own fat. There is therefore no risk of rejection. This procedure allows a re-sculpting of the body by refining the areas of the silhouette with fat deposits that act as donor areas for the transfer. After the procedure, weight fluctuations are to be avoided. Breast reduction Overly large breasts can occur as a result of the overdevelopment of the breasts during teenage years, after pregnancy and breastfeeding, or weight gain. Often they trigger back, neck and shoulder pain and also great discomfort for the patient when performing day-to-day activities or sports. The procedure can be performed at any age with the condition that the mammary gland has stopped its development. This means that even women as young as 18 years old can benefit from the procedure. Indications for breast reduction Mammary hypertrophy. Overly large breasts that are also sagging Constant pain on the back, neck, shoulders Breasts that are heavy and asymmetric An off-centered mammary gland, with a not very appealing curve Skin sagginess and stretch marks on the breast skin envelope (the appearance that the breasts are held in place by just the skin and nothing else) General anesthesia is used for the procedure. The duration of the intervention is dependent on the complexity of the case, meaning the amount of mammary gland, skin and fat tissue to be removed. During the procedure, the plastic surgeon will perform an excision to remove a part of the mammary gland to get the desired reduction in size. The fat and skin tissue that are in excess will also be removed. A potential breast ptosis (a usual occurrence when it comes to overly large breasts) will also be corrected during the procedure. Also, the nipple and areola complex is centered and its size reduced if necessary. The benefits of the surgery can be reaped immediately after the procedure as the pain that came from the overly large breasts should be alleviated. It can take up to six months to evaluate the final results of the intervention properly as the breasts might be swollen and bruised after surgery. Breast lift Breast ptosis is defined by breast sagging. The beauty of the breasts depends on a harmonious balance between the envelope of the breast (the skin) and its contents (the glandular and fat tissues). When this equilibrium is broken, the ptosis appears. The artifice of a bra becomes essential to camouflage the fact that the breasts have lost their perkiness and have a lower position on the chest wall. The breast lift is performed for purely aesthetic reasons on women of all ages, but specifically for women with multiple pregnancies that were affected by weight fluctuations and aging as well. Indication for a breast lift – At home, you can do the “pencil test” to self-diagnose breast ptosis. This test involves placing a pencil in the inframammary fold. If the pencil falls down, you do not suffer from breast sagginess. If the pencil is retained in the submammary fold, it is confirmation that there is a collapse of the skin on the breasts. A specialist will confirm if the ptosis is effective by a clinical examination and can determine the best course of action. – If your nipples are facing downwards. – If a significant part of the mammary gland is positioned under the level of the inframammary fold. The intervention consists of performing a plasty to elevate the breasts and bring them a harmonious curve. There is not a single technique we can use to treat ptosis but several, and the choice will depend on the anatomical data of each patient. Breast lift techniques are often associated with breast implant surgery or breast reduction. The procedure is performed under general anesthesia, and the duration of hospitalization is generally 24 hours. The breast lift consists of concentrating the mammary gland, removing the excess skin, raising the areola and nipple and then to re-drape the breast. A possible asymmetry is corrected. The bust is re-sculpted and the breasts are rejuvenated, rounded and harmonious. Conclusion Nowadays plastic surgery offers numerous interventions that can improve the appearance of your bust. Among them are breast augmentation, breast reduction, and breast lift. Each procedure can be performed using different surgical techniques that are adapted from patient to patient with the goal to achieve specific objectives. Breast augmentation and breast reduction offer immediate results with final results being visible after three to six months. In the case of a breast lift, the results can be evaluated once the swelling and bruising have subsided, but the elevation of the breasts on the chest wall is noticeable from day one following the intervention. The procedures are, in a vast majority of cases, performed under general anesthesia.