I see many variations of patients in my San Francisco Bay Area/Marin County plastic surgery practice that are primarily seeking correction of sagging breasts and often looking for  more youthful and fuller upper breasts.  Often because of pregnancy, breast feeding or simply a weight loss, the breasts begin to look flattened at the upper poles, the cleavage is much less firm and the general volume of the breast itself is greatly reduced.   At the cosmetic surgery consultation, I am often asked if a breast augmentation alone will “fill up” the breast enough to correct the sag.  The answer is sometimes.  Not a very definative answer and here is why.  A minor amount of sag in a small to medium sized breast is often correctable with an implant.  The implant diameter must be appropriately sized in order to achieve a natural cleavage.  If  too small diameter implants are placed, the breasts seem as if they are spaced too far apart.  When the implants are too large, the breasts seem very close and the breasts appear too large for the woman’s chest.  Sometimes,  the best solution is to lift the breast while enlarging it to a naturally full and youthful size again.  The desired outcome of breast augmentation is a larger breast with the nipple at a natural position.  It is not aesthetically pleasing to have a nipple that continues to point downward, even though the breast is fuller. A quick consultation can confirm the appropriate solution to accomplish the desired correction.

Recent years have also brought the advent of implants with moderate to high projection.  These are valuable tools because I often see small chested women that request large breasts.  When a standard moderate implant is used, the diameter of the implant may be too large for the chest.  The patient almost always is desiring projection rather than breasts that fill the entire chest wall.  A high profile implant will have the same amount of fill volume but with a smaller diameter.  Thus, more projection is achieved with a more natural look to the chest wall.

I perform a variety of different breast procedures but always recognize in the surgical planning that the outcome should correlate to the patients lifestyle, athletic choices and desired result.  

For the past 11 years, liposuction has always been the top surgical procedure.  This year breast augmention has taken over with liposuction as 2nd, eyelid surgery 3rd, rhinoplasty 4th and abdominoplasty 5th.  Botox continues to lead the nonsurgical procedures as most popular with  laser hair removal and hyaluronic Acid dermal fillers in popularity.

The top 2 procedures for women were breast augmentation and liposuction.  The top 2 procedures for men were liposuction and rhinoplasty, with eyelid surgery following the top two for both sexes.    At my Marin County cosmetic surgery practice, I would probably designate vaser liposuction and eyelid surgery as my top 2 requested  procedures.  Often, different areas are addressed at the same  time surgically,  particularly with mommy makeover  (breast and tummy)  and facial surgery.  Of  interest this year is the increased usage of dermal fillers and Botox for patients interested in correcting minor facial issues with little downtime.