Breast Surgery: As with All Things, Timing is Everything

You’ve looked at your breasts every day since you hit puberty and are amazed at the changes. Today, you may see your breasts as too big, too small, or too low. Unfortunately, too many women have had to cope with the loss of a breast. For all of these reasons, breast operations are and will continue to be some of the most common procedures done in the United States. Perhaps you’ve decided that staring at your chest and doing nothing is no longer an option. But when is a good time to get things done?

There is no one answer for every woman. However, there are things to think about when considering any breast operation – starting with age.

Prior to age 18

Breast operations may be done prior to age 18 in the case of cysts, masses, absent breast(s) from birth defects, or severe breast enlargement. However, the vast majority of breast operations should be done after a girl has reached the age when she can legally make the decision for herself.

Breast augmentations as graduation gifts for high school seniors make eye-catching headlines but really aren’t a great idea. These operations will change things for a LIFETIME and are not to be taken lightly. Additional operations will be necessary because breast implants don’t last forever – so make sure this is right for you or your daughter.

Child-bearing years

Breastfeeding is an important issue for many women so it’s critical to know that any breast operation can eliminate the ability to breastfeed your child. Breast reductions, in particular, leave more than 50 percent of women unable to successfully breastfeed. Be honest with yourself about your future children. If you feel it is critical to do everything you can to maximize your chances of breastfeeding, then wait until after you’ve had all of your children. If you are pregnant or breastfeeding, don’t have breast surgery. I recommend waiting at least 3 months and preferably 6 months after completion of breastfeeding your final planned baby to ensure that your breasts have returned to their new normal. It’s important to realize that this new “normal” may be quite different from your pre-pregnancy/breastfeeding “normal.” Breasts, like everything, change with age, gravity, and each pregnancy.

Weight gain and loss

Weight gain and loss will both affect breast size. Many women with large breasts are trying to lose weight, but their breasts get in the way by making clothing and activity more difficult. In a perfect world, your weight would be ideal and stable prior to any breast operation. But we don’t live in a perfect world. If your breasts are getting in the way of weight loss, then by all means get them reduced. However, if you have a breast reduction and then lose a lot of weight, your breasts will end up smaller and perhaps more droopy than they would have been (but still better than if you hadn’t had the reduction). By the way, a reduction includes a lift, which reproduces a more youthful form.

During or after breast surgery

Whether to have breast reconstruction at the same time or after, removal for cancer is something many women must decide. There is no single “right” answer.

Some women want to get through the process as quickly as possible. Others are overwhelmed with the diagnosis of cancer and adding anything else to their plate is unthinkable. It is critical to evaluate your life situation, the severity of the disease, and the need for chemotherapy or radiation. Offering breast reconstruction at the same time as a mastectomy can get you on the road toward physical and mental healing. It’s also important that reconstruction not get in the way of that healing.

Obviously, the details of these discussions can’t be covered here. But I strongly recommend a thorough discussion with your oncologist, your breast surgeon, any family or friends whose opinion you value (don’t, however, have them make those decisions for you) and, if you are considering some reconstruction, make time for a plastic surgeon. Do reconstruction because you want to, not because you feel you have to for someone else. Do it when it works for you, not when it might work for others.

Choose wisely

I am hoping that this information gives you some insight into breast surgery and its timing. Another important point is to choose a plastic surgeon that is certified by the American Board of Plastic Surgery so you know your surgeon has the training to provide these breast operations. It’s also important to choose a plastic surgeon that has privileges to do these operations at your local hospital (whether the operation is done there or not). This ensures that a thorough evaluation of the surgeon’s training has been completed and he or she has the ability to care for you in the event that hospitalization is required.

Timing any of these operations to fit your life is a very important part of the surgery’s success. Choose wisely!

(Alex Lechtman, MD, is a Board-certified plastic surgeon with The Aesthetic Center of Kaweah Health Medical Group.)