While many women of color want to lift their self esteem (and stop a few health problems) by having a breast reduction, some are stopped in their tracks due to the possibility of scarring. Why? The procedure requires long scars on the breasts.  (A breast lift will also produce long scars.)

Over time, the scarring lightens but as skin color becomes darker – as with American Indians, some Latinas and African-Americans — special problems can develop.

Fifty percent of women with darker skin are prone to a type of scarring known as Keloid; these scars appear as wide, heightened and thick and grow outside the boundary of the incision, often like a large, flat tumor.

Moreover, Keloids are often painfully itchy. Those scars are often found on various parts of the body, including the breasts. Keloids are very difficult to treat. Surgeons can treat the scars with drugs that act on the immune system, can surgically remove the scar or use a combination of the two. Lasers are sometimes used but, like in surgical treatments, patients often see a recurrence of about 50 percent. (Read more about Keloids and darker skin in plastic surgery.)

Some plastic surgeons eschew the knife and use liposuction instead to reduce the size of very large breasts, thereby avoiding longer incisions altogether.

Because the average breast is usually more than half fat, an average liposuction reduction makes a breast about two sizes smaller while making sure future problems with Keloid scarring does not happen.

Breast reduction surgery may be necessary because extremely large and heavy breasts:

• Cause back and shoulder problems and other medical problems
• Create grooves in shoulder bones due to the weight placed on bra straps
• Make finding clothing difficult
• May be covered by medical health insurance

Some health insurance companies cover breast reduction because the woman’s health is better with  smaller breasts.

Do you have scars? How did they heal?

It was not for nothing that breast surgery lead the list of plastic surgery procedures in 2007 with 437,400 patients. It’s extremely popular!

However, there are many elements to breast augmentation, meaning many decisions to make. Among them are:

• Saline or silicone breast implants

Many patients report that silicone is softer and has a more natural feel. However silicone implants cost more. Patients must also decide if the implant goes over or under the chest muscle.

• Motivation

Plastic surgeons report that women who ask for breast augmentation often have uneven or different size breasts. Some women have lost breast shape because of normal aging while others have gained a lot of weight and then lost it all. In many cases, breast size is lost through nursing and pregnancy.

• Cost

According to the American Society of Plastic Surgeons (ASPS), the average surgeon’s fee is about $3800.  But additional fees are necessary: one each for the operating room, the implants and an anesthesiologist, all of which can add another $1800 to $3000 onto the total cost.

A typical total cost of breast augmentation in the U.S. averages between $6000 and $8000.

• Future procedures

Breast enhancement is rarely a one-time event. Most women with breast implants should plan on having at least one more procedure within about ten years. Sometimes, the patient wants a smaller bust line or time takes its toll on the implant.

• Incision

Breast augmentation offers four possible routes for putting an implant under a breast.

Three involve three to four inch incisions and scarring :

• Under the breast where the gland meets the chest wall
• Through the armpit
• Through the areola

The scars almost always are well hidden, heal well and lighten over time. The fourth approach is the TUBA through the belly button; that method requires the smallest incision of all.

• Complications

Even in the best of hands, complications happen.
Possible — but rare — complications include:

• Infection
• The breast hardening due to a type of internal scarring known as capsular contracture.
• Rupture and leakage
• “Bottoming out:” the implant falls out of its pocket

Your best bet? See a board certified plastic surgeon. With five to seven years extra training, he or she has seen it all and immediately knows what to do.

How would you decide on breast surgery?

Breast augmentation, the most popular plastic surgery procedure in 2007, saw 348,000 procedures performed. That’s a six percent increase over the amount done in 2006. (2007 is the most recent year for which statistics have been compiled).

But now, people are budgeting hard during the economic downturn and looking for bargains wherever possible. So, if you are willing to haggle a little, you may be able to shave the total cost of a breast enhancement somewhat. Tips include:

1. Have surgery during a slow season

Typically, plastic surgeons who perform procedures on the body are the least busy when school is out. Talk to the practice’s business manager and ask if a discount would be available in return for scheduling surgery when the doctor is not very busy.

2. Sign up for fill-in surgery

Plastic surgeons need to keep their operating rooms full because idle hands must be compensated nonetheless. If you can arrange your schedule so that you can have surgery with only five to ten days notice, you may be able to get yet another discount. Reason? Patients are always cancelling for many good reasons and it’s hard to find fill-in patients on short notice.

3. Pay in cash

If you can pay in cash or by check, you may be able to get a small discount. It’s because credit card companies also charge the surgeon when you pay with plastic.

4. Ask about manufacturer specials

Sometimes, manufacturers have promotions on various types of breast implants.  For instance, the surgeon may get three free sets of implants when buying larger lots of inserts. The doctor can then pass savings onto the patients.

5. Have several cosmetic surgery procedures in one surgical session

If you are having breast enhancement, ask if any discounts are available on a second procedure like upper eyelid lift and a third like liposuction. A five percent discount for the first additional procedure and 10 percent discount for the second is typical.

Some prime candidates for breast augmentation, in areas such as Brea, CA, are women weight lifters who have hit the gym - and their workouts - so hard, their bust size decreases. Sometimes, their chests are flat.

According to plastic surgeon Rick Silverman, M.D., a champion body builder himself,  notes that women weight lifters tend to have flat, but muscular, chests and would be perfect candidates for breast implants.

If the woman is also competing in a body building contest, breast surgery can help her win. How? Judges want to see as much difference as possible between male and female body building contestants.

While Dr. Silverman admits that, in rare cases, it’s possible for a woman body builder to break a breast implant while doing vigorous chest exercises, it very rarely happens.

According to the doctor, it’s best to place the insert under the chest muscle because more tissue and muscles cover the implant, creating a look more natural look for the judges.

The big hold up, says Dr. Silverman is that many women weight lifters are so devoted to their training schedules, they don’t want to stop working out for the six weeks required to make sure proper healing takes place after surgery.

Look at some breast augmentation  before and after plastic surgery pictures of typical patients.

What do you do for exercise? Ever try weight lifting?

TUBA is beloved by many women because it inserts breast implants through a tiny opening in the navel and leaves no other scars.

And while the New York Times has called Dr. 90210’s Robert Rey, M.D. “the most famous plastic surgeon in America,” what the article does not say was that he owes it all to the TUBA.

While in medical school, Dr. Rey learned the then-new technique of inserting breast implants through the belly button.

In 2000, when Dr. Rey came to California he gave a receptionist at the E! Channel in Beverly Hills a TUBA procedure and she raved about it. More women asked for the procedure and word spread throughout the building. Soon, he was asked to appear on a new reality show - Dr. 90210 — about plastic surgeons. The rest, as they say, is history.

The TUBA procedure can be done because plastic surgeons use an instrument known as an endoscope. Inserted just under the skin, the endoscope contains a bright light and camera on a tiny cable. The image then appears on a television monitor.

The plastic surgeon watches the monitor to see where the tools are inside the body; the tiny tools are also inserted under the skin.

Using different, long surgical tools under the skin, the surgeon reaches up to the breasts and creates pockets for the implants. He or she then rolls up the breast implants like cigars, inserts them into the belly button opening and works them into the pockets under the breast.

Then, the inserts are inflated with saline through a long filler tube. (Read more about the difference between saline vs silicone breast implants.) The filler tube seals upon removal while only several stitches are used to close the incision in the navel.

View some breast augmentation before and after pictures.

If a recent report is true, plastic surgeons from Los Angeles to New York are going to quit making nursing the bug bear of drooping breasts.

Until now, when a woman requests a breast lift, the surgeon usually explained the drooping of her breasts to one of three things:

• Breast feeding
• Loss of massive amounts of weight (MWL)
• Older age

Consequently, many women concerned about their figures choose not to breastfeed, even though the practice is known to transfer certain health benefits to babies.

But now, several plastic surgeons have studied women with one pregnancy behind them and who later asked for aesthetic breast surgery. (Many moms request breast lift with breast augmentation.)

Plastic surgeon Brian Rinker, M.D., from Lexington, Kentucky, took a close look at the records of 93 women who had at least one pregnancy and some form of breast surgery. Dr. Rinker and his colleagues then assigned to each patient the degree of pre-surgical sagging – technically known as ptosis (pie-toe-sis) –from zero to three.

Dr. Rinker and his colleagues then interviewed each patient and collected information on:

• Age
• Number of pregnancies
• History of breastfeeding
• Duration of breastfeeding
• Body mass index (BMI)
• Pre-pregnancy bra size
• Weight gain during pregnancy
• History of smoking

But when the doctors crunched all the numbers, they found the following factors were more serious risks for drooping breasts:

• Higher age
• Greater BMI
• More pregnancies
• Larger pre-pregnancy cup size
• Smoking

Notably absent from leading risk factors: breastfeeding, even when the woman nursed for longer periods of time. (Read more about the study on sagging breasts.)

Says Alan H. Gold, M.D., president of the American Society for Aesthetic Plastic Surgery (ASAPS): “Patients need to be armed with objective data….when making important health decisions.”

Dr. Gold also said the study should be repeated with larger numbers of patients to really nail down breast feeding’s effect on the breasts.

Have you ever nursed? What happened to your bust line?

Before going ahead with a breast augmentation, many former patients say they should have asked more thorough questions during the first consultation with their plastic surgeon.

Top Ten Questions to Ask:

1.    Are you certified by the American Board of Plastic Surgery and where do you have hospital privileges?

2.    How many breast enhancements do you perform every month?
(Surgeons who do many breast augmentation surgeries each month produce less bruising and swelling because they disturb fewer tissues. You’ll heal faster and go back to work sooner.)

3.    Have you performed a breast augmentation on any of your staff or any patients that may   be waiting for a follow-up visit? May I speak to one or two?

4.    Which breast implant size, texture and filling (saline or silicone) best suits my frame and body size?

5.    Do you have any technique that can give me an idea of what my breast size will look like before going ahead with surgery? Do you have a list of frequently asked questions?

6.    How long can I expect a breast implant to last before I need another surgery?

7.    Which incision placement for the implants do you prefer and why?
(Implants can be inserted through the areola, the armpit or the belly button)

8.    Do you prefer to place breast implants over or under the chest muscle? Why?

9.    Would you give me the total cost of plastic surgery, including surgeon, anesthesiologist and O.R. fees, along with any charges for post-op special garments and medications?  May I have it writing?

10.    How long will my recovery take and are there any special post-op instructions?

How would breast augmentation suit you? See more questions about breast augmentation or view some before and after breast augmentation photos.

Not every patient pays the same amount for plastic surgery procedures like a breast augmentation.

The professional plastic surgery societies list the average surgeon’s fee for breast enhancements done by their members during a particular year. But real prices vary widely, according to where you live, from the Big Apple to the Inland Empire in California, and how much training the surgeon has. Board certified plastic surgeons tend to charge more.

For instance, the American Society of Aesthetic Plastic Surgery (ASAPS) says the average fee for inserting saline implants into small, symmetrical breasts is $3,583. The fee for placing silicone into similar breasts is $4,005.

According to the American Society of Plastic Surgeons (ASPS), the average surgeon fee among their members for breast augmentation is $3,816.

But don’t confuse surgeon fees with total prices.

For instance, there is usually a fee of $500 to $800 for the surgical facility.

The anesthesiologist will charge a fee of $500 to $800.

A separate fee is usually charged for the implants, with silicone being more expensive.

Pre-surgical medical tests, medications and medical tests can run another $100 to $300, depending on your health condition and the tests you need.

Before you leave your initial consultation, ask your surgeon for the total price. He or she may ask for wiggle room of five to 10 percent to allow for unforeseen circumstances during surgery.

According to the website, RealSelf.com, consumers in various cities reported the following total charges for a breast augmentation:

• Rockville, Maryland, silicone: $10,000.
• Jupiter, Florida, silicone: $9,000.
• Dallas, Texas, silicone: $8,500 (“I’m 47 with 20-year-old boobs!”)
• San Francisco, silicone: $8,000.
• Huntington Beach, California, silicone, $7,000.
• Scarsdale, New York, silicone: $6500

Have you ever had a breast augmentation? Was it expensive?

One of the biggest concerns expecting mothers seem to have is whether or not breast implants decrease the likelihood of breastfeeding. Although I would love to give you ladies a definite yes or no answer, I am afraid it is a little more complicated than that.

Like everything in life, breast implants also come with a risk. Although unlikely, breast implant surgery may cause damage to nerves, milk ducts, and milk glands. This may lead to a decrease in the amount of milk produced by your breast and/or a decrease or stop in the flow of breast milk.

HOWEVER, research shows that most women who undergo breast implant surgery are still able to breastfeed afterwards. Remember, the breast augmentation technique is also an important factor to consider in that certain surgical methods have higher risks associated with them in terms of breast feeding. Where your implants are placed are also significant in determining the affect of implants on your ability to breastfeed. Breast implants can be placed under the chest muscle to prevent damage to milk ducts and glands. You may also worry that chemicals in the implants will mix with the breast milk. Good news ladies! Research shows that both saline implants and silicone implants pose no harmful effect.

Although you and I can’t predict the future (unfortunately) and cannot control the outcome of surgery,  letting your surgeon know of your concerns,  can help him/her to select the surgical techniques that coincide with your best interest.

A Los Angeles breast augmentation is a procedure that you can rely on if it is performed by a qualified plastic surgeon. What makes for a qualified plastic surgeon in the Los Angeles area or any area in the United States? First, the plastic surgeon must be board certified by the American Board of Plastic Surgery which is recognized by the American Board of Medical Specialties. This means that the plastic surgeon that performs surgery in Los Angeles for breast augmentation has graduated from an accredited medical school and has at least five years of specialty training, with at least two years focused entirely on plastic surgery. It’s this type of certification and focus that sets a plastic surgeon apart. Any type of surgery is a procedure that a patient must not take lightly. By visiting a qualified plastic surgeon, you are better assured that your procedure will be performed properly and safely.