Q. I had a breast augmentation when I was 25.  I am now 35 with three children.  I feel like my breasts are smaller than they were before children and would like to go larger.  Is the surgery to place bigger implants more or less involved than my first surgery?

A. As a general rule, the surgery to replace implants in order to go larger is a much simpler procedure than the first time they were placed.  The pocket for the implant is already present, and although some adjustment to the pocket size will have to be done, most of the work has already been accomplished.  The one thing that you need to make sure of is that you have not developed any droopiness of the breasts related to pregnancy and nursing.  If you have, then a breast lift may be advised in order to return your breasts to your pre-pregnancy look.  At the time of your consult, a few simple measurements of your breast will determine whether a lift is necessary.  As for recovery after an implant replacement, you can expect to be able to return to driving and work in about 48 hours and back to the gym and unrestricted exercising in about 1-2 weeks.

Q. I have large breasts that cause back pain and restrict my ability to exercise.  I am middle age and have never had children.  I had a consult with a plastic surgeon and was told I am candidate for a breast reduction, but I do not want the scars that he told me about.  I saw online that liposuction can be used to reduce the breasts.  What is your opinion on liposuction?

A. Yes, liposuction is an option for a very small percentage of patients desiring breast reduction.  I typically do not recommend it since this technique does not allow me to tighten the skin if there is any ptosis (sagginess), which many women with large breasts have.  However, if your breasts do not need to be lifted, liposuction may be an option.  The best candidates are patients who are close to normal weight, do not have any ptosis, and most importantly, have a predominately “fatty” breast.

Let me explain what I mean by fatty.  The breast is composed of two types of tissue: glandular tissue, which is the milk producing tissue, and fat, which gives the breast its softness.  Some women have predominately glandular tissue with less fat.  These women tend to have firmer and denser breasts and are not candidates for liposuction.  On the other hand, some women have more fat than glandular tissue which tends to be large but not as heavy or dense.  If there is not much droopiness in the fatty breasts, the patient may be a candidate for liposuction.  You should be aware that there are limitations of what can be achieved with breast liposuction, the most important of which is that there is no option to accomplish lift.  Therefore, if your breasts are large and sag, you will end up with smaller breasts that still sag.  Secondly, the amount of tissue that can be removed via liposuction is sometimes not enough to achieve the desired result.  The best way to know if you are a candidate for liposuction breast reduction is to see an experienced breast surgeon.

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William Byron Barber II, M.D. has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com