Facts to Know

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1. According to the American Society for Aesthetic Plastic Surgery in 2006, nearly 11.5 million cosmetic surgical procedures were performed in the United States, an increase of 98 percent between 1997 and 2006. Additionally, for the first time, breast augmentation surgery—a procedure that increases breast size and volume—surpassed liposuction as the number one surgical cosmetic procedure for women, with more than 380,000 procedures performed.

2. In 2006, an estimated 104,455 breast reductions were performed, a 23 percent increase over 2000. The procedure is often performed to relieve significant health and emotional problems resulting from overly large and/or heavy breasts, including neck and back pain, shoulder pain, chafing or rash, significant limitation of activities, unhappiness with appearance, chronic headaches and nerve damage. Psychological issues include depression and stigmatization, poor self-esteem and anxiety, and problems finding clothing that fits.

3. Whether you choose to have your breasts increased in size, lifted or reduced in size, it's important that you understand not only the benefits of the procedures, but also the risks, costs (health insurance rarely pays unless there is some medically necessary reason for the surgery) and various surgical options available, and that you choose the right physician. Your surgeon should be board certified by the American Society of Plastic Surgeons, have privileges at a local hospital and be trained in the technique you've chosen.

4. Most women opting for breast surgery are young and healthy; however, a full medical evaluation is still required. For instance, if you smoke or are overweight, your health care professional may counsel you to quit smoking and/or lose weight, both of which reduce the risk of complications from surgery.

5. Very few insurance companies cover breast augmentation or breast lift for cosmetic reasons, and costs for the surgeon's fee alone can run more than $3,000. You'll also have to pay for the operating room, postsurgical hospital stay, anesthesia, and related costs. However, the significant emotional and physical repercussions of large breasts mean that many health insurance companies are willing to pay for breast reduction surgery even though it's still considered a "cosmetic" surgery. Some insurance companies may require that a certain amount of breast tissue be removed. Check your policy, including whether or not your surgeon needs to write a "predetermination letter."

6. There are two types of breast implants, silicone shells filled with saline or sterile salt water or, more recently, with silicone gel. Silicone gel-filled breast implants are thought to provide a more natural appearance, and they're less likely to deflate. Today's silicone-gel implants also benefit from 15 years of improved manufacturing technology that reduces the risk of rupture and leaking. After a 14-year ban, the FDA has approved the sale of silicone gel-filled implants for breast reconstruction in women of all ages and for breast augmentation in women 22 and older.

7. During breast augmentation surgery, the breast implants are placed behind the breast tissue (called subglandular), primarily in women who have enough underlying fat to cover the implant, or behind the chest muscles (called submuscular).

8. Breast implants carry a relatively high risk of complications. A New England Journal of Medicine study cited by the FDA found that 24 percent of women who had undergone breast implant surgery had complications requiring re-surgery within the first five years. Studies show that about nine percent to 11 percent of women require additional surgery because of scar tissue that forms around the implant, causing it to thicken and contract, called capsular contracture. The risk of capsular contraction, however, is less when the breast implant is placed in the submuscular position.

9. Similar to other medical devices, breast implants—saline or silicone—are not lifetime devices. It is likely that at some point they may need to be removed or replaced. A U.S. Food and Drug Administration study found that one third of the 907 women interviewed said they had at least one operation to replace or remove a breast implant, and the average time between getting implants and having additional surgery was 11.5 years. If your breast implants need to be replaced or removed you'll be responsible for covering the costs of the surgery.

10. The American Society of Plastic Surgeons notes that the best candidates for mastopexy ("breast lifts"—surgery that lifts sagging breasts) are healthy, emotionally stable women with realistic expectations of what the procedure will accomplish, particularly women with small, sagging breasts. If you haven't finished childbearing, however, the ASPS recommends you wait; another pregnancy and breastfeeding may stretch your breasts again, although the procedure doesn't affect your ability to breastfeed. However, keep in mind that the results aren't permanent; eventually, gravity and age will again take their toll.