As a plastic surgeon, certified by the American Board of Plastic Surgery, I appreciate the changes that occur to the breast after multiple pregnancies.  In general, it is possible to lift sagging breasts and maintain the approximate breast volume, assuming the skin has loosened.  The most important thing is the affect of a heavy breast on future sagging of the breast.  If the breasts are very heavy, the skin will stretch out and sag against the heavy weight of the remaining breast tissue.  I typically recommend that women find a breast size that matches their frame but also allows the breast to maintain a "perky" appearance.  If the breasts are sagging, typically due to heavy size, but the skin is not loose, the breast size must be reduced to allow for lifting of the breast.  Regarding the nipple ring, my patients are expected to remove the ring during the immediate surgery period, usually only 5 to 7 days.  It is possible that the piercing will close, but unlikely, requiring re-piercing.  On a side note, I usually recommend women get close to a reasonable weight for their height to allow for the best results.

Breast Lift

I would not recommend an abdominoplasty at the time of a spinal fusion for several reasons. Technically, the combined procedure would be compromised by the relative inability to flex the table which is necessary in order to remove the appropriate tissue and achieve the best possible result. Second, the braces often worn after spinal surgery can rub and cause difficulty for the patient. Pressure or friction on freshly operated skin should be avoided. I would recommend that you determine which issue is more significant and treat the problem initially.

Tummy Tuck

I will focus the discussion on saline (sterile salt water filled) implants. Typically, saline implants are very durable and retain their form very well. The primary risk unique to breast implants includes leakage, which is not a health risk, and scar tissue formation around the implant, leading to a change in the feel or appearance of the breast. Fortunately, these complications do not happen very often and your board certified plastic surgeon can assist you if these problems occur. Breast implants that are currently approved for use do not have expiration, so you do not remove them unless there is a problem. It is important to understand that breast, with or without implants, age like the rest of the body. The heavier the breast, relative to the support of the skin, the greater is the tendency for sagging over a lifetime. Your surgeon will help you find the right size to minimize these changes. The most important thing to remember is that with realistic expectations and understanding of the risk/benefits, the vast majority of breast augmentation patients are very happy. For additional information, refer to www.surgery.org and www.plasticsurgery.org.

Breast Augmentation

In general, it is best to have breast enhancement surgery when you are at least 18 years of age, if it is done for purely cosmetic purposes. The breast can take 18 years or more to reach full development, which is the best time to consider surgery. The second issue is consent. Breast enhancement surgery is very safe and rewarding, but there are risks that exist. At 16 years of age, your legal guardian must consent to breast augmentation for you. This may make your family and your surgeon uncomfortable. The last major issue is the likely change in your desires after high school. I have followed young women, who ultimately have breast enhancement at 19 or 20 years of age. Their desired size and shape changed over time. They also seem to appreciate the process more when they are making all the key decisions with the surgeon. Ultimately, I recommend you wait.

Breast Augmentation

Thank you for asking such an important question. Breasts with implants change with time and weight fluctuations. It is very likely that your implants can be removed safely and a breast lift performed. Often the remaining breast tissue can be rearranged to fill in the space made by the implant. Women are able to get smaller, up-lifted breasts without deformity. It is important to know that in some instances, your surgeon may want to do surgery in two steps. If your surgeon thinks that your breasts will pull up/fill in after the weight of the implants are removed, that may be an option. It is important to seek a surgeon certified by the American Board of Plastic Surgery and to discuss all of the risks and benefits of surgery.

Breast Augmentation