Breast augmentation (augmentation mammoplasty) is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

• To enhance the body contour of a woman who feels her breast size is too small.
• To correct a reduction in breast volume after pregnancy.
• To balance a difference in breast size.

The best candidates for breast augmentation are women who are looking for an improvement, but not perfection, in the way they look: the smaller the size of the implant, the more natural the post-operative results will look and feel. A breast implant is a silicone shell filled with salt-water solution known as saline. The Food & Drug Administration (FDA) has once again determined that silicone gel-filled implants are safe and silicone gel implants are now available for breast augmentation patients. Doctor Harris has been certified to use silicone gel breast implants and Dr. Harris does perform silicone implant breast augmentation at this time. Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem is "capsular contracture", which occurs if the scar around the implant tightens. This squeezes the implant and can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or replacement of the implant. As with any surgical procedure, excessive bleeding following the operation may occur and another operation may be needed to remove the accumulated blood. A small percentage of patients develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients. There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery.  Eventually, all breast implants break or leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, the gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. This requires another operation and replacement of the leaking implant. A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective-tissue disorders," but the FDA has requested further study. While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant. In your initial consultation, Dr. Harris will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure. The method of inserting and positioning your implant will depend on your anatomy and Dr. Harris' recommendation. The incision is usually made in the crease where the breast meets the chest. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Working through the incision, Dr. Harris will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. Some surgeons believe that putting the implants behind your chest muscle may reduce the potential for capsular contracture. Drainage tubes may be used for several days following the surgery. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue. The operation usually takes one to two hours to complete. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

When a breast augmentation is performed, the actual breast implant can be placed in one of two positions: under the muscle, or over the muscle. The muscle that this refers to is the pectoralis muscle, the strong chest muscle that can be seen when you flex your chest.

Also called subpectoral (under the pectoralis muscle), this approach positions the implant between the muscle and the rib cage. Typically, the muscle will cover the upper 2/3 of the implant similar to a vest. The lower 1/3 of the implant is covered by the natural breast tissue. This positioning helps to provide a natural, tear-drop shape to the breast. A subpectoral placement is often chosen for women with smaller natural breast volume and those with a minimum amount of sagging of the breasts. Advantages of placing the implants below the muscle include a more natural overall breast shape, decreased likelihood of interfering with breastfeeding and a decreased incidence of contracture (hardening).

There is no single approach that is ideal for every patient. At the time of your consultation, Dr. Harris will discuss with you in detail the options for implant placement so as to best meet your personal goals and expectations. At the time of your consultation, it is a good idea to bring a bra that it approximately the size you would like to eventually be - that way you can try on implant sizers.

A breast-lift is done for patients whose breasts have "sagged" or "drooped" over time, due to pregnancy, aging, weight fluctuations or heredity. The operation is similar to a breast reduction; however, breast tissue is usually not removed. Also known as mastopexy, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. Unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious. Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. Breast reduction is not recommended for women who intend to breast-feed. As with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. The procedure leaves noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.) Dr. Harris will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) Breast reduction is always performed under general anesthesia. You'll be asleep through the entire operation. Dr. Harris uses a procedure that involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. He removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.) After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two. Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy. Breast reduction scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, Dr. Harris will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.

Flap reconstruction. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant. This type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour. Depending on the extent of your surgery, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years, but they'll never disappear entirely.  As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction. Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.

Gynecomastia is a medical term that comes from the Greek words for "women-like breasts." Though this oddly named condition is rarely talked about, it's actually quite common. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases. For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured. As with any surgery, there are risks, including infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year. Treatment of gynecomastia may be covered by medical insurance--but policies vary greatly. Check your policy or call your carrier to be sure. Smokers should plan to stop smoking for a minimum of four weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Surgery for gynecomastia is usually performed on an outpatient procedure under a general anesthesia. Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. The chest will be wrapped to keep the skin firmly in place. To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent. Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.