Cosmetic breast surgery is a surgical procedure to change the size or shape of the breasts.

Cosmetic breast surgery can be done in an outpatient surgical facility or in a hospital. Most people are asleep and feeling no pain (general anesthesia), although local anesthesia may be used to numb the area around the breasts.

For a breast reduction, the surgeon removes some of the breast tissue and may move the nipples higher on the breasts for cosmetic reasons. In general, the operation lasts 3 - 6 hours.

During a breast lift, the doctor makes incisions along the natural creases in the breast and around the dark skin surrounding the nipple (areola). A keyhole-shaped incision is made above the areola to define the new location for the nipple. The surgeon removes skin from the lower section of the breast and raises the areola, nipple, and underlying breast tissue. The nipple is moved and incisions are closed with sutures. The procedure can last 3 - 5 hours, depending on the extent of the surgery.

If you are considering cosmetic breast surgery, talk to a plastic surgeon. Discuss your expectations about looking and feeling better, keeping in mind that the desired result is improvement, not perfection. Emotional stability is an important factor. Breast surgery can renew your self-confidence and improve your appearance, but the rest is up to you.

You may need mammograms or breast x-rays before the surgery. The plastic surgeon will perform a routine breast exam.

Mastopexy is typically done to lift sagging, loose breasts. The size of the areola, the dark pink skin surrounding the nipple, can also be reduced.

Breast reduction may be recommended for:

• Colored bra-strap groove
• Cystic breast infections (polycystic mastitis)
• Enlarged breasts (macromastia)
• Pain from the weight of large breasts that is not relieved by a supporting bra
• Arm or finger numbness caused by large breasts
• Back pain, neck pain, or shoulder pain
• Breast pain
• Headache
• Loss of sensation in the breasts
• Poor posture caused by large breasts
• Sleeping problem caused by large breasts
• Scar-like lines (striae) on the breasts

Breast reduction is not recommended if you have one of these conditions:

• Breast cancer
• Cellulitis
• Hardened breast skin

In addition to the general risks of surgery and anesthesia, other risks include:

• Inability to nurse a baby after surgery
• Large scars with prolonged healing time
• Uneven position of the nipples
• Sensory loss

The emotional risks may include feeling that the breasts don't look perfect, or that people's reactions are not adequate.

After breast lift surgery, a bulky gauze dressing will be wrapped around your breasts and chest, or you might wear a surgical bra. You can control your pain with medication. It should subside in 2 - 4 days.

After a breast reduction you'll probably need to stay in the hospital overnight to control pain and nausea. Within the first week, the dressing will be replaced by a soft bra, which you must wear for several weeks.

Generally within a few days the swelling and discoloration around the incisions will disappear. You may have a temporary loss of sensation in the breast skin and nipples after surgery. This condition will improve with time. Within 2 weeks of surgery, sutures will be removed.

You are likely to have a very good outcome from breast reduction surgery. Your appearance and lifestyle activities can be significantly enhanced. Also, the pain or skin symptoms (such as striation) disappear. You may need to wear a special supporting bra for a few months to reshape your breasts.

While you are healing, limit physical activities to prevent the scars from stretching. You might be able to do some activity within 1 - 2 days after surgery. The plastic surgeon will recommend a schedule for resuming your usual routine (usually about 8 weeks). To permit proper healing, avoid overhead lifting for 3 - 4 weeks.

Scars are permanent and often remain highly visible for a year following surgery, then fade to some degree. The doctor will make every effort to place the incisions so that scars are as hidden as possible. The scars should not be noticeable, even in low-cut clothing (incisions are usually made on the underside of the breast).