When I first opened my private practice in 1997, the thought of putting breast implants into a woman who was having a breast reduction was ridiculous, bordering malpractice. If you have more than enough volume, just leave the right amount behind and avoid the potential complications of breast implants altogether.

As regular readers of my blog know, I am constantly reevaluating my results, in the attempt to further enhance what is possible while remaining safe. The only disappointment in breast reduction results has been a lack of fullness in the upper part of the breast, the same as in breast lift surgeries. What could I do?

I have, over the years, found that adding an implant to breast lifts increased patient satisfaction, as the breast appeared more youthful with the extra volume up top, kind of like many young actresses you’d see. I had corrected old overreduced breast with implants before as well. Why not add an implant to the reductions, just reducing a little more to achieve the same volume in a different distribution?

There are technical considerations, as you have to be careful with the blood supply to the nipple, and the surgery needs experience and careful planning. It costs more, and you have to consider the additional risks of having breast implants, such as leakage and hardening.

Just like in life, the things that sound crazy to you when you are young sometimes make a lot of sense as you get older.