Breast cosmetic surgery is defined as any medical procedure that penetrates beyond the surface of breast skin. Breast cosmetic surgery ranges from procedures as limited as a needle biopsy, to something as complex as microsurgical post-mastectomy breast reconstruction. Breast cosmetic surgery can be defined in two broad categories:
• Procedures to diagnose and treat breast disease including cancer and benign cysts, tumors, and growths
• Procedures to change the appearance of a breast, including restoring the absence of a breast, increase or decrease in breast size, or revision of breast shape and position.
Recently, however, a third category of breast cosmetic surgery has emerged: surgery to prevent breast disease. While prophylactic bilateral mastectomy has been elected as early as the 1980s to significantly reduce a woman’s chances for developing breast cancer, it only recently has become an accepted practice in the prevention of breast disease in women who are carriers of the breast cancer genes BRCA1 and BRCA2. Studies show that there is a 90% reduction in the incidence of breast cancer among these women. However, recent studies have demonstrated that even women who are not carriers of the breast cancer gene can, in fact, reduce their chances of developing breast cancer. In a study published in the June 2004 issue of Plastic and Reconstructive Surgery, women with overly large breasts and without the presence of certain genetic factors relative to breast cancer who underwent breast reduction were found to have a reported 50% to 70% reduction in the incidence of breast cancer. Beyond the categories of breast cosmetic surgery to either treat disease or change appearance, breast cosmetic surgery can also be defined by medical specialty:
• General breast cosmetic surgery: to diagnose and treat breast disease through the removal of the entire breast, or only of diseased tissue, tumors, or cysts
• Cosmetic surgery of the breast: any surgical procedure that changes or restores the appearance of the breast, including those procedures to treat and prevent breast disease that result in the change of breast appearance
Cosmetic surgery of the breast can change breast appearance by:
• Making large breasts smaller (breast reduction) • Making small breasts larger (breast augmentation)
• Restoring the appearance of a sagging, flat breast (breast lift)
• Restoring the appearance of a breast disfigured or removed by disease (breast reconstruction)
• Restoring symmetry to the appearance of the breasts following surgery to treat disease or reconstruct a breast
• Restoring a more normal appearance to breast anomalies or congenital (from birth) and developmental deformities: misshapen or tubular breasts, breasts that develop disproportionately, and correction of rare conditions such as the presence of more than one nipple on the breast
• Treating breast disease while preserving the most normal appearance of the breast; this includes the removal of cysts and tumors, breast conserving surgery, skin sparring mastectomy, and mastectomy
Although cosmetic surgery can change the appearance of the breast in many different ways, based on the many different cases that present, the goal for cosmetic surgery of the breast is always to restore or retain a normal appearance. In some cases, a more normal appearance simply means bringing balance to a woman’s figure. In others it requires complete reconstruction of a breast and surgery to alter the appearance of the opposite breast to match the size and position of the breast that is reconstructed. Yet while cosmetic surgery of the breast may have one common goal for all women, it remains a highly individualized procedure based on:
• A woman’s preferences and perceptions for her body
• A woman’s physical anatomy and her figure
• A woman’s overall health and prognosis
• The recommendations of a qualified board-certified cosmetic surgeon
As much as these factors influence what cosmetic surgery of the breast can achieve for a woman, they equally are limitations to what, in some cases, cosmetic surgery of the breast may not be able to achieve. For example, while breast reconstruction can create a very natural appearing breast in which a woman may have some sensation, in no way can cosmetic surgery of the breast create a breast to exactly replace one in appearance, function, and sensation that is lost or disfigured by surgery, disease, or even accidental trauma. Consider, too, that there are limitations for a woman who desires to increase breast size so significantly that her present skin cannot possibly stretch to accommodate the size of the implant. Equally, there may be limitations for a woman with enormous breasts who wishes to retain the ability to breast-feed after reduction. Despite modern techniques that retain the function and sensation of the nipple, if a woman’s breast size is primarily mammary tissue, reduction will, in fact, affect a woman’s ability to breast-feed. Cosmetic surgery of the breast can make a remarkable difference in the appearance of a woman’s breast, in the way a woman sees herself, and in the way others see her. But women must approach what cosmetic surgery of the breast can achieve with realistic expectations: cosmetic surgery of the breast can improve the appearance of a woman’s breast and her figure as a whole, but it cannot achieve perfection. Based on a woman’s current physical condition and what it will take to achieve realistic goals, there are always tradeoffs. These trade-offs, however, are well worth it for the over one half million women who undergo plastic surgery of the breast each year in the United States.
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1. Where to start when wanting to undergo breast cosmetic surgery
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