Changes to the breasts can be caused by a variety of factors, including pregnancy, breastfeeding, menopause, and weight changes. Some women with smaller breasts may experience ptosis (sagging breasts) and want to get the entire package when they consult their surgeon. Larger or medium-sized breasts can dwindle over time, and this is often accompanied by a drooping of the nipples.

There are many obvious benefits to a procedure that could offer women the chance to combine their breast augmentation and mastopexy during a single surgery:

• final results in a single session
• less time spent in the operating room and hospital
• no need to operate on scarred tissues

But is this sort of procedure safe? Some physicians have argued that combining breast augmentation and mastopexy creates added risks, such as scarring, death of breast tissue, and poor positioning of the implants. Surgeons have argued that the operation is complicated and unnecessarily risky.

However, in a recent study published in Aesthetic Plastic Surgery, Dr. Ariel Tessone and her colleagues were able to employ a safe, simple mastopexy-augmentation technique that involves resectioning the breast after the implant has been inserted. The study examines 60 patients who underwent this procedure. It reports a high satisfaction rate and a low (10 percent) reoperation rate.

While there are various considerations outlined in the study that would limit the use of this procedure, it seems that augmentation-mastopexy surgery may be a viable option for patients who want to correct both breast sagging and loss of breast volume.

For Lindsay, who graduated ten years ago, breast augmentation fit the bill. Though her father was hesitant, her mother sympathized with Lindsay’s struggle to find clothing that fit well. After some research, Lindsay’s parents gave in to her request.

While Lindsay said it was was the right time in her life, even looking back, some parents are more reluctant to allow their children to undergo cosmetic surgery.

Though her mom suggested laser hair removal, Lexy, 14, was unsure of the necessity at first and did not mind shaving. But after experiencing irritation, Lexy decided to undergo the $900 series of treatments and is now interested in more cosmetic surgery. Her mom, however, does not feel the same way and refuses to let her daughter dramatically change her body.

Though Lexy’s mom resisted more involved procedures, plenty of teens around the country are choosing more than laser hair removal. Skin resurfacing and injection treatments like Botox are also a hit among teens. Teens also have a high interest in breast augmentation and liposuction.

Even with all this interest, and her own cosmetic surgery success story, Lindsay urges teens to think about why they want the procedure.

Lindsay said each person must first be happy with themselves before surgery and told prospective teen patients to “think it through and make sure you’re doing it for the right reasons.”

Dana Van Gray, 38, who underwent breast augmentation and a tummy tuck a year after having her last child said she felt the need to seize the opportunity and said the positive change in her body improved her attitude.

“I feel good so I can be a better mom to my kids,” Van Gray said.

A “mommy makeover” is not one procedure, but actually a variety of surgeries that help women regain their pre-pregnancy physiques. Breast augmentation helps restore volume to breasts that may have begun to sag after breastfeeding. Meanwhile, a tummy tuck removes excess skin and tissue that may hang around the midsection after childbirth. Also a part of many “mommy makeovers” is a breast lift, which removes sagging breast tissue to restore the breasts to a more youthful position. This procedure may include the placement of breast implants to replace lost volume. The ASPS recommends that new mothers wait six months to a year before undergoing any of these procedures and that they lose weight before surgery.

ASPS President Dr. Phillip Haeck said more and more, the women who are electing these procedures are not older women, but younger mothers like Dana. He attributes this to improving attitudes toward cosmetic surgery and an openness about the desire to change what diet and exercise may fail to.

We encourage you to learn more about the mommy makeover procedures like breast augmentation, tummy tuck and breast lift and to consult with your plastic surgeon about what surgery may help you achieve your aesthetic goals.

The study, which was published in March, examined women who had undergone breast lipomodeling as an alternative to more traditional implant-based breast augmentation. It found that 16 months after the procedure, more than half of the women displayed no abnormalities that would cause an issue on a mammogram. Of the women who did show any abnormalities, they were minor issues like scarring or small calcifications.

The study also compared mammograms for women both before and after breast lipomodeling and found no significant differences in the mammogram results.

Breast lipomodeling was originally introduced as a means for breast reconstruction following a mastectomy. In the cosmetic procedure, your plastic surgeon would use liposuction to remove excess fatty deposits from a donor site on your body, like the hips or thighs. After it has been purified, your plastic surgeon then uses lipomodeling techniques to inject the fat into your breasts, giving them volume and improving the shape.

While the results of the ASPS study are only preliminary, they bode well for the continued adoption of breast lipomodeling in the plastic surgery breast augmentation canon.

A research team at the University of Michigan investigated the effectiveness of MRI scans in detecting breast implant ruptures and found that among women who had no symptoms, the ruptures often went undetected. For women who had experienced symptoms of a ruptured implant, such as hardening of the breast or pain, detection rate was much higher. In a mixed screening of women with and without symptoms, ruptured implants in those with symptoms were twice as likely to be detected by the MRI.

Researchers said that the average age of the ruptured implants they saw was ten years—implants are not guaranteed to last a lifetime and often need to be replaced.

Though this data may be disconcerting, the study’s authors said further research needs to be done to determine the effectiveness of detecting a ruptured implant through an MRI. They also urged that the long-term health effects of a ruptured implant need further study.

Plastic surgeons successfully use breast implants as part of breast augmentation to increase breast size and projection as well as in breast lift surgeries to lift sagging breasts, which may have also lost volume.

Plastic surgeons in the Phoenix area say they are seeing a dramatic uptick in the number of individuals who are coming in during tax season, using their tax refund check to cover all or part of a procedure.

Kristy Harris in Phoenix chose to use her tax refund to pay for part of her breast lift surgery and used some savings to cover the rest of the $8,400 procedure (cost based on patient-reported averages on RealSelf.com). The mother of two said that raising children took a toll on her body and she wanted to do something to help herself achieve a “different look.”

Another popular procedure for the breasts is breast augmentation, which costs approximately $6,600. This surgery can improve shapeliness and body proportion.

Liposuction remains one of the most sought-after body procedures and costs about $5,600. Liposuction is often performed to remove stubborn fat deposits nearly anywhere on the body.

Even if your tax refund check is a bit smaller than you would hope, non-surgical treatments are available at a fraction of the cost of surgery. The ever-popular Botox, is used to reduce lines and wrinkles on the face. Chemical peels are also non-invasive and remain one of the key facial rejuvenation treatments and work to reduce many skin imperfections like a dry, dull complexion, blemishes and pigmentation issues. Botox and chemical peels cost about $472 and $610 for full treatments, respectively.

Awake surgeries are now being noticed not for the beautiful results they yield (they often do not), but rather the unsafe conditions and unprofessional manner in which they are conducted. According to an article on msnbc.com, patients who have undergone Awake procedures, such as extensive liposuction and breast augmentations, are now raising their voices against the doctors who performed the procedures with little training that left them in great pain and with poor results.

These patients’ stories stress the importance of looking into your plastic surgeon’s background and making sure he/she is board certified to perform the procedure you wish to undergo.

Awake patients are given an unknown mixture of drugs without an anesthesiologist present. Aside from a cheaper cost, the main selling point of Awake procedures is that the patient remains somewhat conscious during the procedure and can evaluate the result before completion of the surgery, however, with an unknown amount of drugs coursing through their system, it’s unclear how lucid these patients truly are.

Philadelphia plastic surgeon Bruce Genter says there are instances when local anesthesia is appropriate (with sedation), but a skilled plastic surgeon knows when general anesthesia is necessary.

“Most often sedation is needed for large operations with local anesthesia, but at a certain point, general anesthesia makes more sense,” Genter says. “Too much local anesthesia can result in dangerous overdoses.”

The final chilling fact about Awake procedures is that for a doctor to perform Awake procedures (as approved by a nebulous “academy” located in Arizona), he/she only needs to undergo two days of training, whereas a board certified plastic surgeon has undergone years of training and a residency program.

To avoid the pain, both physical and emotional, and the poor surgical outcome, it is important to keep a few things in mind when looking into a cosmetic procedure.

• Research your surgeon and verify that he/she is board-certified to perform the procedure
• Insist on an open dialogue with your surgeon and learn about the techniques he/she uses
• Ask to see before and after photos from the surgeon’s previous patients and read patient testimonials, if available

We encourage you to learn more about how Portland-area plastic surgeon Dr. Michael Workman safely performs liposuction and breast augmentation procedures with beautiful results.

“I do see a fair amount of parents coming in with their child because of bullying and teasing and feelings of self-consciousness,” says cosmetic surgeon Dr. Michael Fiorillo.

Erica Morgo was one such child, who sought a nose job at 15 after being taunted for years by her classmates because of her large nose.

“I felt helpless. I felt like a loser,” said Morgo about the effects of the bullying. “I tried breaking my nose once. I was so fed up with the bullying that I tried banging my face against the door.”

In addition to acting in self-harm, Erica Morgo also reported missing about a month of school in an effort to avoid facing her tormentors, and finally her mother, Dana Manzella, decided enough was enough and allowed her daughter to have plastic surgery.

“I think that was definitely a good decision, because it brought her back — her self-esteem back up to be able to do activities that she did before, with comfort,” Manzella said.

Manzella also allowed her younger daughter, Breanna Morgo, to start having Botox injections a few times a year to correct her droopy smile at age 5.

“We only do it twice a year — in September for school pictures, and then again in June for her birthday,” Manzella said of Breanna Morgo’s Botox regimen.

Although Manzella has no qualms about her daughters’ cosmetic procedures, child psychiatrist Dr. Ned Hallowell thinks that Manzella and parents like her may be putting their children at unnecessary physical and psychological risk.

“The idea of someone getting plastic surgery to avoid bullying seems to me as crazy and worrisome as if a black person were to go to a doctor and say, ‘I wanna become white to avoid racism,’” Dr. Hallowell said. “The problem is clearly with the phenomenon of bullying, and not with the person’s nose.”

Still, despite the objections of Hallowell and other teen plastic surgery critics, nearly 90,000 teenagers had cosmetic surgery in 2007. The procedures most commonly sought were rhinoplasty, breast reduction, breast augmentation, ear surgery and Botox.

While many plastic surgeons will decline to operate on teens unless they present a serious or pronounced physical deformity, other surgeons believe that some teens are mature enough to make the decision to undergo cosmetic procedures (with parental consent).

“My preference is, of course, to work out the issues first, the bullying, the teasing. But there are certain situations where people are mature enough. And surgery is a final resort,” said Dr. Fiorillo.

In general, the issue of whether to operate on a particular patient, regardless of age or emotional maturity, is a decision left entirely up to each individual surgeon, so it is important to consult with a Lake Oswego plastic surgeon whose ethics and judgment you trust before you (or your teen) pursue elective surgery.

Brandon Alleman and his team of researchers at the University of Iowa surveyed 45 companies that facilitate medical tourism for U.S. patients and found that these companies have referred only about 13,500 U.S. residents to healthcare and cosmetic surgery facilities outside the country.

These companies represent about 70 percent of the market serving U.S. medical tourists, so if, say 23,000 American patients traveled abroad for medical treatments, that makes up only a tiny fraction of the number of patients treated in the U.S. each year.

This is good news to Portland plastic surgeon Dr. Michael Workman, as he and many of his colleagues, as well as respected plastic surgery organizations like the American Society of Plastic Surgeons, discourage American patients from traveling abroad for cosmetic procedures like liposuction, breast augmentation and even injectables for a number of reasons.

For instance, countries outside the U.S. where plastic surgery is less expensive often do not have adequate standards of care and official oversight designed to prevent avoidable complications and poor outcomes.

There is also concern over whether medical tourists actually receive treatment with the products or devices they think they are getting, and that they paid for. Many patients think they’re getting Botox or Restylane, but end up getting cheap knock-offs of the real thing, along with poor results.

In addition, most plastic surgeons agree that it is important to receive follow-up care from the physician who performed the procedure, which is not usually possible weeks or months after surgery, when patients have returned to their homes in the U.S.

In fact, the study results showed that 93 percent of companies brokering medical tourism packages expect follow-up care to be performed by U.S. physicians.

Given the fact that many physicians are uncomfortable providing follow-up care to patients on whom they did not perform the initial surgical procedure, it can be not only difficult to find a physician who will provide post-surgical follow-up care for patients who have traveled abroad for cosmetic surgery, but costly to hire a new physician as well, especially if complications arise and revision surgery is needed.

To avoid the potential risks and difficulties with follow-up care that can arise from medical tourism, it’s best to first choose an accessible, board-certified plastic surgeon who performs surgery and other cosmetic procedures in appropriately accredited U.S. facilities.

Let cost be your final consideration in choosing a surgeon, as paying slightly more for a great outcome the first time can end up being much less expensive than paying separately for follow-up care and multiple revision procedures down the road.

There are also a number of financing options available to Americans who do not have the cash in-hand needed to pay for plastic surgery, so there is little reason to travel abroad when some of the world’s best surgeons are in your own backyard.

While some say they merely want to look and feel better in the wake of the stress and emotional turmoil caused by divorce, others hope their enhanced curves or rejuvenated face will help them find a new mate and even serve as a form of revenge against their former mate for discarding them.

Dr. Michael Cohen said one of his breast augmentation patients, a woman in her 20s who had recently discovered her husband had cheated on her, “suggested to the people preparing her for surgery that it was sort of payback.”

Divorce-inspired plastic surgery is becoming so popular that some physicians have even created “divorce packages,” according to the Washington Post article, which offer discounts to patients seeking plastic surgery after a breakup. One such plastic surgeon, Dr. Stephen Greenberg, says that of the patients taking advantage of the divorce package offered at his practice, about 70 percent are women.

Anne Soriano, a 49-year-old divorcee, said she was motivated to seek Restylane injections to put her best face forward upon re-entering the dating scene. She is also contemplating liposuction to contour her waistline.

Soriano’s attitude is a common one, according to Seattle plastic surgeon and American Society of Plastic Surgeons president Phil Haeck, who said many of his patients come in saying, “I’m going back on the market, and I’m afraid how I look right now isn’t going to work.”

“The first thing [people notice] is the look, unfortunately,” says Soriano, underscoring the reality that finding a potential mate after passing your physical prime can be difficult.

But Dr. Haeck is quick to point out that while having plastic surgery can boost the confidence of men and women looking to make romantic connections, choosing to undergo cosmetic surgery or other procedures during an emotionally unstable time, such as during or immediately after a divorce, can lead to unrealistic expectations and disappointment.

This is especially true for the small handful of patients who think plastic surgery will offer some sort of vengeance against those who rejected them, or incite their dream date to approach them the next day.

“There’s a discussion that has to be had – do they expect to find Superman or Superwoman the next day after they change their appearance? Because that person may not suddenly drop into their lives just because they’ve had something done,” says Dr. Haeck.

However, Haeck agrees, as do patients like Soriano, that surgical and non-surgical cosmetic enhancement can produce subtle changes in appearance and self-esteem, which make it easier to attract and engage strangers and potentially make romantic connections.