A significant part of my practice is breast surgery -- breast augmentation, breast reduction, breast lift and breast reconstruction. I have noticed over the past few years that there are more and more women in the 35 to 55 year old group who want to improve the appearance of their breasts. They usually want to return their breasts to the size and shape they had in the years BC (before children).

However, when I discussed this article with my wife and other women, they all said "do older women really get breast implants?" Well, maybe it's not talked about like it is among the 20 to 30 year olds, but it's just as common. Statistics for 2005 from the American Society for Aesthetic Plastic Surgery reveal that 49% of women undergoing breast augmentation are over 35 and nearly 10% are over 50. Even more amazing is that 75% of breast lifts and 59% of breast reductions are performed on women over 35.

So it's not just my practice, but this is a nation wide trend. So, if you are considering this surgery (and not telling your friends), what do you need to know?

1. Breast surgery is about art and skill and experience.

2. The result is highly dependent on the skill of the surgeon, and is NOT the same from doctor to doctor.

3. There is not one "best choice" of implants, incisions, or implant placement.

4. Each patient is unique and women have different desires and therefore you require an individual analysis and plan.

5. Everything in life has trade-offs and it is my job to educate you as to what these may be for you.

6. Remember that the time spent with your surgeon before the surgery correlates with your result.

7. You need a qualified plastic surgeon certified by the American Board of Plastic Surgery who has the knowledge, judgment, and experience to obtain the best possible result for your individual body type and life style.

While a standard augmentation may be all that is necessary, many women need adjustments in shape as well as size. Some require lifting (mini, moderate, or full). This may include elevation of the nipple and areola, with an incision around the areola and sometimes a vertical incision as well, depending on the degree of ptosis (sagging).

The nipple is not removed and replaced, which is a common misconception. Sensation should be maintained. Women who have had more than one child, or those who breast feed are more likely to need a breast lift. Another common procedure is reduction of the areola size, especially when augmenting the breast size.

A breast lift can also be accomplished without augmentation. If you have sagging but are content with the cup size, a mastopexy (breast lift) alone may be all that is needed.

Only a surgeon with training and experience in all aspects of cosmetic surgery of the breast is qualified to assess and treat this need. Your plastic surgeon should listen to your concerns and develop an individualized plan to avoid problems and increase the likelihood of an outstanding result.