In his 20 years as a cosmetic surgeon, Dr. Alan Lim says that breast surgeries make up the majority of his practice.  "Although body contouring and facial surgeries are popular, more than half my patients are looking to change their breasts," he says. 

Dr. Lim categorizes breast surgeries into four types:

• Augmentation
• Reduction
• Lifts
• Reconstruction

Augmentation
Breast augmentation, increasing breast size with implants, is probably the most well-known form of breast surgery.  One of the most common of all plastic surgeries, breast augmentation has had its share of controversy.  Most notably, in 1992, the Food and Drug Administration placed a moratorium on silicone implants.  However, after years of studies, links between silicone and its purported health ailments could not be supported. In early 2007, the FDA revoked the ban on silicone implants.  Silicone implant leaks -- although rare -- are still a risk.  To that end, a new cohesive gel that does not leak is awaiting approval from the FDA.  "It's like gelatin," explains Dr. Lim, "if you cut it in half, it retains its shape."  This cohesive gel is proving popular in Europe and South America and may one day be the implant of choice in this country. 

Saline, which surged in usage when silicone was banned, is currently the most common type of breast implant in the United States.

Reduction
Breast reduction is sought by women whose breasts are heavy enough to cause neck, shoulder and back pain.  Rashes and painful grooves from bra straps are other symptoms common to women with breasts that are D-cup sized or larger.  Many insurances pay for breast reduction for women who suffer from ailments associated with large breasts.  This surgery involves removing a portion of breast tissue and skin, and repositioning the nipple if needed.

Lifts
Breasts lifts do not change a woman's bra size.  This procedure involves removing "darts" of skin around the breasts to reduce sagging.  "Breasts begin to droop as the skin ages," explains Dr. Lim.  "This problem is exacerbated by pregnancy when breasts grow to accommodate milk.  After the breast feeding period, the breast returns to its pre-pregnancy size -- but the skin may not follow suit." 

Reconstruction
Following a mastectomy, many women choose to have their breast surgically reconstructed.  "Every case is different," says Dr. Lim.  "Some women need one breast reconstructed with an implant.  Sometimes I need to lift, augment or reduce the other breast for symmetry."  He further explains that women have options when it comes to reconstructing nipples.  "I can pucker and tattoo the skin to mimic a nipple.  Some women, after a mastectomy, have no desire for a reconstructed nipple.  In that case, I can tattoo two shades of concentric circles to resemble a nipple, but the breast is entirely smooth."

One, or a combination of more than one of these types of breast surgeries, may be used to correct asymmetrical breasts.  If the asymmetry is significant, as in more than two cup sizes variance between a woman's breasts, insurance may cover this procedure.

Although Dr. Lim performs a variety of plastic surgeries, including face work and body contouring, he specializes in breast surgeries. He has practiced in the Sacramento area for more than 20 years and was recently recruited to Sutter Medical Group for his expertise in breast surgery, specifically to help Sutter Cancer Center's mastectomy patients.

Dr. Lim encourages each patient to discuss potential risks with her doctor.  "Every surgery has risks," he says. "Scarring is likely with any breast surgery," he explains.  "With some patients, scarring may be faint, depending on their skin and type of surgery.  Others may get their desired shape, but not without detectable scarring."  Another common risk of breast surgeries is reduced nipple sensation.  Certain surgeries are more susceptible to this than others, but Dr. Lim recommends that each patient carefully evaluate all possible risks before surgery.

"Breast enhancement surgery continues to be popular for a reason," he says.  "For many, it improves a woman's quality of life."

Sutter Medical Group's Alan Lim, MD, FACS, is board-certified in plastic surgery. For more information, visit his Web page.