The 3 Most Common Procedures with Recovery and Procedure Details


Breast enhancement is perennially the most common aesthetic procedure sought by women of all ages. For many, breasts are an expression of their femininity, yet few are completely happy when examining their reflection. Whether you are considering an augmentation, reduction or a lift there is much to learn about these popular procedures and what factors might influence your decision and/or your surgeon’s recommendations. Understanding the procedure or combination of procedures that best fit your goals is the first important step. Board Certified by the American Board of Plastic Surgery, Dr. Joseph Rucker, has performed over 10,000 reconstructive and cosmetic surgery procedures. Here, Dr. Rucker shares his philosophy and insights on “the perfect breasts” while filtering some of the misinformation and prevalent misconceptions with regard to breast enhancement.

Despite my experience and aesthetic judgment, asking me to define “the perfect breast” is not only misleading, it assumes I can make a unilateral decision on the patient’s behalf. 

Certainly shape, size, position and proportion are important, but my patients have taught me my point of view is not necessarily their perception. Having said that, in general a woman’s profile should present a gentle curve with rounding from the nipple to the chest wall—not down or out, but up. Facing the mirror with arms down, the breast should start at the armpit then subtly extend outward touching the bicep with the nipple positioned slightly upward and roundness evident beneath the nipple in a smooth curve.  Size is very subjective, but should ultimately be proportional. While I am confident in my surgical and aesthetic opinions, my recommendations are always tempered by the patient’s desires and goals.  For instance, some physicians make the mistake of evaluating the ideal shape by looking at the patient through their own eyes versus hearing that patient simply wants to see cleavage when looking down at her breasts. 

One of the most misunderstood procedures is the breast lift. 

When you look at your breasts you most likely evaluate them on size. Am I too big? Not big enough? Simply increasing or decreasing the size of your breasts will do nothing for the positioning of the nipple or the degree of sag. Perhaps you will recognize yourself as being in one of three categories of patients who do well to consider a breast lift. You have had 2 or more children, started as a B cup but went up to a D while nursing. You have stretch marks and your nipples have dropped, cleavage has disappeared and your breasts look “long.” Or you always were a C cup and were successful in losing significant weight. As you progressed to your ideal weight, your breasts lost mass, but the envelope stayed the same, leaving you with “empty pockets.” Lastly, if you are older and notice the elasticity of your breasts gives them the appearance of drooping, a lift will reverse that condition. An easy way to determine if a lift is indicated is to put a pencil under the fold of your breast. If it stays, a lift might be an appropriate course of action. However there are varying grades of lifts, all predicated upon the nipple location. A nipple close to the crease of your breast is grade 1. Below the crease, is grade 2 and a nipple pointing down would be a grade 3. The surgical technique and incision placement is dictated by the degree of lift necessary to restore the breast to a more youthful position. A breast lift can be done as a solo procedure but is most often combined with either augmentation or a reduction to achieve the proper positioning and shape along with the desired size. If you feel your breasts are too long, the nipples are too low and that you have lost your natural cleavage, a breast lift may help you reclaim what you thought was lost forever.

Breast reduction is one of the most rewarding procedures both aesthetically and functionally and in many instances is covered by insurance:   

If you have been self conscious about having large breasts since high school, are sensitive to men always “looking there” or have had to adjust your activity level and clothing to accommodate your chest, you might want to consider a breast reduction. Upper or lower back pain, neck pain, rashes, arm numbness and chest wall heaviness are all physical symptoms that can be attributed to overly large breasts. Breast reduction surgery is a blessed relief for unnecessary pain and suffering, both psychological and physical—so much so that insurance companies recognize the connection and will often reimburse you for the correction. Physical therapy, chiropractic care, muscle relaxers may stem the discomfort temporarily but will not treat the cause. In a breast reduction procedure a predetermined portion of both the breast tissue and skin is actually removed. Most breast reductions will go from a D+ cup to a small or medium C cup.  The nipple areolar complex is left attached so as to preserve sensation and the ability to breast feed.  The two to three hour breast reduction procedure is done in a hospital setting under a general anesthetic, and there is usually an overnight stay required. Contrary to having a simple lift or augmentation, breast reduction requires approximately a 3 week recovery time before resuming normal activities. I’ve performed approximately 2,500 breast reductions on women 25-65. Post surgery advice by those who have had it to those debating? “Don’t wait, I should have done this years ago.”

Breast augmentation has become unnecessarily confusing for the consumer. 

While you could say information is power, the sheer amount of choices available with regard to implant type, size, location and shape can seem daunting. I suggest that patients concentrate on communicating their desired result and let me coach them in their choices on how to get there. Most women want natural, proportional breasts, so usually a moderate profile implant is the best. Under the muscle helps contribute to a less obvious change. Placed too high or too close together will telegraph the fact that you are “enhanced.” Sizing options are determined by a patient’s height, weight and shoulder width, but truthfully most decide on a full C cup with upper pole fullness. Prior to surgery our office will help envision the final result by experimenting with different sized implants placed in a non padded bra. The days of fake, overfilled, improperly placed implants seems to be behind us as are the arguments over the safety of silicone. The latest breast implants are superior to those of the past. Both saline and silicone can deliver beautiful, natural results and each has distinct advantages and disadvantages so you’ll want to know the trade offs. For instance thin women might show a ripple with saline but silicone might dictate where the scar is to be placed. Aside from a conversation about your anatomy and goals, think about if you mind others noticing that you have been augmented (relating to the size you choose)  and aspects of your lifestyle. If you are highly active, I would suggest not going too big.  Breast augmentation is great for increasing size and shape and results permanently with or without clothing. While they are not lifetime devices, many last over 20 years. “The idea is for you to be comfortable in your own skin and confident. Being self conscious defeats the entire proposition. You don’t want others to be preoccupied with your chest. You do want them to leave with the impression that you look great.” 

It is never a good idea to rush into elective surgery, but many women hesitate for the wrong reasons.

Some women who come in for a consultation to increase their breast size are concerned that others might perceive them as being vain, shallow or exaggerating their sexuality. If you are preoccupied by your appearance and find yourself stuffing your bra, buying heavily padded bras or your disparity in proportion causes you to buy bathing suit tops much smaller than the bottoms, and this bothers you, that is a healthy reason for aesthetic intervention. If your breasts have always been large and you long for a reduction but are concerned about finances, you might be surprised to know many of these procedures are covered by insurance.  Simply accepting you will always “be big chested” is unnecessary when a reduction can potentially provide the jump start your self-esteem has been yearning for. If your breasts are good size but sagging, don’t assume this is just another point of surrender to aging. Repositioning the breast through a lift alone or in combination with an augmentation or reduction can make a big difference in your appearance and how your clothing fits. In addition, despite what you might have heard, breast enhancement will not influence your ability to nurse, experience sexual arousal or interfere with a cancer diagnosis. Who is not a good candidate for breast enhancement? The woman who is doing it for someone else.

The optimum age to enhance your breasts.

Improving your appearance can be rewarding at any age provided you have no underlying health conditions that impact the safety of surgery. However, there are some advantages to considering certain procedures during a particular age range. For breast augmentation, anytime between the ages of 21-45 is ideal. Prior to having children you would want the implant under the muscle where it won’t interfere with your ability to nurse. After children, you might have a combination of an augmentation and breast lift because of the toll pregnancy, nursing and gravity takes on the body. Breast reduction is most rewarding in your earlier years so you can enjoy a lifetime without restriction or pain. Prior to your reduction, it helps to be close to ideal weight because significant weight loss will impact the volume and sagging of your breasts potentially necessitating a lift to restore position.   

Special Event Planning

When your RSVP to that special event involves more than injectables, it is prudent to be realistic about healing. The downtime or length of time necessary to appreciate proper results must be taken into consideration.

Breast Augmentation: 6 weeks
Breast Lift: 6-8 weeks
Breast Reduction: 8-10 weeks

Weddings, reunions, vacations and other special events are the perfect catalyst to want to look your best. Keep in mind, the physical and emotional aspects of recovery vary from person to person. Don’t let that special day be compromised because you didn’t give yourself the time you deserved to heal. 
Article by
Eau Claire Plastic Surgeon