Breast surgery encompasses a wide range of procedures that enhance, reduce, or reconstruct the breasts. Breast surgeries are performed for both cosmetic and reconstructive purposes. Some of the most common procedures include:

• Breast augmentation – Uses implants to increase breast size and fullness. This is the most popular cosmetic procedure nationwide.
• Breast lift – Also known as mastopexy, this procedure raises and firms the breasts by removing excess skin and tightening breast tissue.
• Breast reduction – Removes excess fat, tissue, and skin to achieve a smaller breast size. This can relieve physical discomfort for women with very large breasts.
• Breast reconstruction – Rebuilds the shape and appearance of the breast, often after a mastectomy for breast cancer treatment.

It’s important to carefully research and select an experienced, board-certified plastic surgeon when considering breast surgery. Look for surgeons who are fellowship-trained in breast procedures and have a proven track record of successful outcomes. High volume surgeons who perform hundreds of breast surgeries per year tend to have greater expertise.

The American Society of Plastic Surgeons reports that over 300,000 breast augmentation and 100,000 breast lift procedures were performed nationally in 2020. Breast surgeries are among the top 5 cosmetic surgical procedures. Thousands of women undergo cosmetic and reconstructive breast surgeries each year.

Breast augmentation, commonly referred to as a “boob job”, is one of the most popular cosmetic procedures. This surgery aims to increase the size and enhance the shape of the breasts through the use of breast implants.

There are two main types of breast implants used:

• Silicone implants – Silicone implants are pre-filled with a silicone gel. They feel more natural than saline implants. Silicone implants require a larger incision but tend to give a more realistic look and feel.
• Saline implants – Saline implants are filled with a sterile saltwater solution. They feel firmer than silicone and are inserted empty then filled during surgery. Saline implants require a smaller incision.

The incision location for implant placement depends on the type of implant, degree of enlargement desired, and surgeon preference. Common incision sites include:

• Inframammary – an incision made underneath the breast in the crease.
• Periareolar – an incision along the lower edge of the areola.
• Transaxillary – an incision made within the armpit.

Breast augmentation is typically performed as an outpatient procedure under general anesthesia. Recovery time is around 1-2 weeks, with exercise and strenuous activity restricted for up to 6 weeks. There will be swelling and discomfort during the initial recovery period that subsides over time. Most patients can return to work within a few days.

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Breast Lifts and Reductions

Breast lifts and reductions are common procedures for women seeking to reshape or resize their breasts. During a breast lift, excess skin is removed and the remaining tissue is tightened to lift the breasts into a more youthful position higher on the chest. Breast reductions remove excess fat, glandular tissue, and skin to reduce the size and weight of heavy, pendulous breasts.

There are a few techniques surgeons may use to perform breast lifts and reductions:

• Crescent lift: A small crescent of skin is removed above the areola. This lifts the nipple and breast mound slightly.
• Donut lift: The areola is reduced in size by excising skin at the perimeter. This can help raise the nipple position.
• Vertical lift: An anchor-shaped incision going around the areola, down to the crease under the breast, and horizontally along the crease. Excess skin is removed and the remaining tissue pulled taut.
• Inverted T lift: Similar to a vertical lift, but with an additional horizontal incision made along the crease under the breast. This allows even more skin removal and a greater lift effect.

For breast reductions, the surgeon will make incisions around the areola, down the breast, and along the crease. The nipple is left attached via a pedicle containing nerves and blood vessels. Excess fat, glandular tissue and skin are removed and the nipple is repositioned higher on the breast.

Benefits of breast lifts and reductions include:

• More lifted, youthful, and proportional breast contour
• Relief from neck, back, and shoulder pain caused by heavy breasts
• Better fit into clothing and undergarments
• Improved self-confidence and body image

Proper patient selection and surgical technique are key to achieving optimal, long-lasting results.

Breast Reconstruction

Breast reconstruction is an option for women who have undergone mastectomy due to breast cancer or other conditions. The goal of breast reconstruction is to recreate the shape, appearance, symmetry and size of the removed breast mound. There are several techniques available:

Implant-Based Reconstruction

This involves placing a breast implant under the chest muscle or behind the breast tissue to recreate breast volume. Round saline or silicone implants are commonly used. This is a quicker procedure with shorter recovery time compared to flap techniques.

Autologous Tissue Flap Reconstruction

The patient’s own body tissue is used to reconstruct the breast. Common donor sites include the abdomen, back, thighs or buttocks. Some flap techniques offered in Dr. Hardaway’s clinic include:

• DIEP flap: Uses skin, fat and blood vessels from the lower abdomen.
• LAT flap: Uses tissue from the upper back/shoulder blades.
• IGAP/SGAP flaps: Uses tissue from the buttocks and hips.

Flap procedures require microsurgical expertise to connect blood vessels. Recovery is longer but the reconstructed breast has a natural feel and appearance.

Nipple and Areola Reconstruction

Once the breast mound is reconstructed, nipple and areola reconstruction is done as a separate outpatient procedure. Tattooing creates the areola’s pigmentation. The nipple can be reconstructed using local skin flaps or tissue grafts. This final step completes the reconstruction process.

Breast reconstruction is highly customized for each patient’s unique anatomy and cancer treatment. We have top plastic and reconstructive surgeons experienced in various techniques who help women restore their femininity and confidence after mastectomy.

Choosing the Right Plastic Surgeon

Choosing the right plastic surgeon is one of the most important decisions when considering breast surgery. Make sure your surgeon is board-certified by the American Board of Plastic Surgery, which indicates the surgeon has undergone extensive specialized training in plastic surgery procedures and patient safety.

Look for a surgeon who has considerable experience performing the specific type of breast surgery you desire. Ask how many procedures they have done, and request to see before-and-after photos of their patients. This will help give you an idea of their skill level and aesthetic results.

Many plastic surgeons have online galleries showcasing breast augmentation, lift and reduction results. Browse these photos with a critical eye, taking note of aspects like scarring and symmetry. Natural-looking outcomes and beautiful results are key.

Schedule in-person consultations with potential surgeons. Come prepared with questions about their training, experience, techniques and more. A reputable surgeon will take time to address all your concerns. Take note of how comfortable you feel with their bedside manner as well.

Patient reviews of plastic surgeons can also provide insight into overall satisfaction and quality of care. Look for surgeons who are consistently praised for their surgical expertise, compassionate manner and attentiveness during the recovery process.

Choosing a board-certified surgeon with an artistic eye, stellar reviews and experience with your desired breast procedure can help ensure you achieve beautiful, natural-looking results you love. Also many surgeons will be able to combine your breast surgery procedure with body contouring surgeries as well, improving your overall look.

What to Expect: Pre-Op and Post-Op Care

Before undergoing breast surgery, patients will typically need to complete certain presurgical testing and appointments. This includes medical clearances, lab work, and imaging if needed, along with a pre-op visit to review instructions.

Patients are advised to stop smoking and avoid blood-thinning medications like aspirin for 1-2 weeks prior to surgery. The night before surgery, you may be instructed to wash with antibacterial soap and avoid eating or drinking after midnight.

On the day of surgery, you will check in to the surgical facility and get prepped by the nurses. The anesthesiologist will administer either general anesthesia or local anesthesia with sedation, depending on the procedure. You will wake up in the recovery room once surgery is completed.

Initially after surgery, you can expect to have drainage tubes in place to reduce swelling and prevent fluid buildup. Bandages, support bra, and/or compression garment will provide comfort and support as you heal. Pain medication can help manage discomfort.

The first 24-48 hours are focused on rest and recovery. Your surgeon will give instructions on wound care, showering, arm mobility, and more. Follow all directions carefully to prevent complications like infection or poor scarring. Take short, gentle walks to improve circulation.

By one week post-op, initial swelling and bruising should start to subside. Stitches may be removed around this time. You’ll likely return for follow-up visits at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Let your surgeon know about any concerns with healing, pain, or appearance.

Recovery Timeline

The recovery timeline can vary depending on the type of breast surgery performed.

For breast augmentation or breast lifts, you can expect:

• The first 24-48 hours: Moderate discomfort, swelling and bruising are common. You’ll likely have dressings and a surgical bra or ace wrap. Rest and limit arm movement.
• 1 week post-op: Stitches are removed and a new bra may be fitted. Swelling has gone down some but bruising may still be present. You can resume light activity.
• 2 weeks: Most patients feel comfortable to return to desk jobs or light household chores. Avoid lifting anything heavy.
• 4-6 weeks: Strenuous exercise and activity can gradually resume. Swelling continues to go down.

For breast reductions or breast reconstruction:

• The first 48-72 hours: Dressings, drains and compression garments will be in place. Follow limited arm movement instructions.
• 1 week: Drains are removed. Stitches may be taken out. Continue resting.
• 2 weeks: Can likely return to desk job. Avoid heavy lifting or exercise.
• 4 weeks: Light exercise may be permitted by your surgeon.
• 6-8 weeks: Can resume strenuous exercise or athletic activities.

Regardless of procedure, your plastic surgeon will provide you with detailed guidelines on returning to work, driving, working out and other regular activities. Follow their instructions closely for proper healing. Swelling can persist for several weeks or months after surgery as the breasts settle into their new shape and position.

Risks and Complications of Breast Surgery

Breast surgery, like any medical procedure, does carry risks and the possibility of complications. Being informed and choosing an experienced, board-certified plastic surgeon can help minimize these risks. However, it’s important to discuss potential complications thoroughly during your initial consultation.

Infection

One of the most common complications is infection at the incision site or around the implant or tissue expander. Signs of infection include redness, swelling, pain, and fever. Infection can occur in the first few weeks after surgery or even later on. Serious infections may require hospitalization for IV antibiotics or even removal of the implant.

Capsular Contracture

This occurs when scar tissue forms around the breast implant, causing it to feel firm and leading to changes in shape and appearance. It may occur soon after surgery or years later. The cause is not fully understood. Mild contracture may only require massage while severe cases need surgery to remove or replace the implant.

Necrosis

Also called tissue death, necrosis happens when part of the breast skin or tissue does not get adequate blood supply. This is a serious complication that requires prompt surgical debridement to remove the necrotic tissue and prevent further spread. Smoking dramatically increases the risk.

Careful surgical technique, using antibiotics, gentle handling of tissue, and post-op care help lower risks. But complications can occur even with the most experienced surgeons. Thoroughly discuss your medical history and risk factors with your plastic surgeon.

Insurance Coverage and Costs

The cost of breast surgery can vary significantly depending on the type of procedure, surgeon fees, anesthesia fees, and facility charges. When it comes to insurance coverage, there is an important distinction between reconstructive and cosmetic breast surgeries.

Reconstructive breast surgery, such as procedures done after a mastectomy for breast cancer treatment, is often covered by health insurance. Women’s Health and Cancer Rights Act (WHCRA) provides protections for breast cancer patients who choose reconstruction, requiring health plans that cover mastectomy to also cover reconstruction. Make sure to check your specific health insurance policy for covered services.

For cosmetic breast surgeries like breast augmentation or lift, insurance typically does not provide coverage. These elective procedures are paid out-of-pocket by the patient. Breast reduction may be covered if deemed medically necessary to alleviate symptoms like back or shoulder pain.

On average, the total cost of breast augmentation surgery in Michigan ranges from $5,000 to $10,000. A breast lift usually costs between $4,000 to $6,000, while a breast reduction is $5,000 to $12,000 on average. Many plastic surgery practices offer financing options to break up these costs into more manageable monthly payments. Companies like CareCredit provide special financing for cosmetic procedures, often with zero-interest promotional periods.

When budgeting for your breast surgery, be sure to account for the surgeon’s fee, anesthesia fee, operating room charges, implant costs (if applicable), and any postoperative garments or medications. Getting an itemized cost breakdown before committing to surgery can help avoid surprise expenses. If you have flex spending or health savings accounts, you may be able to use these pre-tax dollars for reconstructive breast surgery costs.

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Frequently Asked Questions About Breast Surgery

Breast surgery is a complex and personal decision. Here are answers to some of the most common questions patients have when considering breast procedures