context: There are three general categories of cosmetic surgery performed on the breasts (also called mammoplasty): breast augmentation, breast reduction, and breast reconstruction. Breast augmentation is performed to enhance the appearance, size, and contour of a woman's breasts. Women consider breast augmentation for many different reasons. Some women feel their breasts are too small. Some desire augmentation after their breasts change after pregnancy. Others desire to correct an asymmetry in breast size. Breast augmentation is performed with implants (see below) that can be placed under a chest muscle or over a chest muscle. The incision can be placed in the axilla (armpit), areola (the area surrounding the nipple), or lower breast fold. In general, all breast augmentations are minimally invasive procedures. For augmentations in which the incision is made in the armpit, an endoscope (thin tube with a small camera and light) may be used during the procedure. Breast implants are made up of a silicone shell filled with either saline (a salt water solution) or silicone gel. A woman determines her desired size by fitting trial implants. Currently, saline filled implants are used on an unrestricted basis. Silicone gel filled implants, once banned by the FDA, are available only to women participating in approved studies. Breast augmentation is a relatively straightforward procedure. As with any surgery, some uncertainty and risk are expected. Know your concerns and expectations. Review the benefits, risks, and alternatives. Seek consultation with a board certified plastic surgeon. Breast reduction surgery is often used in women with large, heavy breasts who experience significant discomfort including neck pain, back pain, and numbness or weakness due to the weight of the breasts. During this procedure, excess skin, fat, and breast tissue are removed. After surgery, breast reduction can cause a change in breast sensation as well as the inability to breastfeed. After breast reduction, most women report relief from the symptoms caused by having oversized breasts. For more on this topic, see the article on breast reduction surgery. Breast reconstruction surgery is often performed in women who undergo mastectomy as a treatment for breast cancer. The procedure recreates a breast with the desired appearance, contour, and volume. The nipple and areola are also recreated. Normal breast sensation and normal breast function, as with nursing, do not usually return when the sensory nerves or milk glands and ducts have been removed or significantly injured. The appearance, contour, and volume of the breast can be recreated with implants or with a woman's own tissue. If an implant is used, the implant is sized to match the opposite breast. When possible, the implant is placed beneath a chest muscle. A breast also can be recreated using a woman's own tissue. At times, a segment of the lower abdominal wall can be used. Other tissue options for autologous (using your own tissue) reconstruction are back muscle and skin or fat and muscle from the buttock. Sometimes surgery on the opposite normal breast will be required to create symmetry with the newly reconstructed breast. Breast reconstruction can be done at any time after you have had a mastectomy. The procedure has no known effect on the recurrence of cancer and it does not appear to affect cancer surveillance. However, you will be instructed on breast self-exams and scheduled for routine follow-up appointments for surveillance. In some women, the skin is not strong or resilient enough to support the weight of the breast, causing the breasts to sag. With this condition, called ptosis, there is too much skin compared to breast tissue. To give the breast a lift, the excess skin must be removed. There are several surgical techniques used including: Wise pattern. The incision, in the shape of an anchor, goes around the chest and below the breast. Le Jeour. The incision goes around the areola and down. Donut or peri-areolar. The incision goes around the areola only. This surgery involves some degree of permanent scarring, but products are available that may help to minimize the appearance of scars. Federal law requires that insurance covers breast reconstruction after a mastectomy. In the case of a cosmetic procedure, however, you should check with your insurance company for details, and talk with your doctor about associated costs. It's important to know that if you've undergone breast implantation either as an aesthetic or a reconstructive procedure, your health insurance premiums may increase. Will my policy cover the costs of the surgery, the anesthesia, and/or other related hospital costs? ( If the carrier only covers a percentage, make sure you know that figure. Additionally, write everything down, including the first and last names of the person answering your questions). Will there be an increase in my insurance premium? Will future coverage be affected?