Will Breast Density Limit My Plastic Surgery Options?

Getting good news about breast density and plastic surgery options

The last time you got your mammogram results, did you notice a little note about your breast density? If you are like 40 percent of women, it might have said something like, “Your breasts are heterogeneously dense, which may obscure small masses and may put you at greater risk of developing breast cancer in the future.” Though this may sound a bit scary, it’s actually a normal reading.

Normal breast density exists on a spectrum from not dense at all to extremely dense. Knowing this information is important; it helps women and their doctors decide which breast screening methods are best, and how often they should get them. According to the American Cancer Society, whether a woman has dense breasts or not, regular screenings (mammograms in particular) are still the best way to find cancer early.

Because of the relationship between breast density and cancer risk, it is now the law in many states that breast density information be conveyed to each woman who has a mammogram. You may have seen talk of this newer legislation on the news.

What this means is that more women than ever before know that breast density matters, and many can tell you just how dense their own breasts are. Knowing this has also left some women wondering if their breast density will affect their options when it comes to cosmetic breast surgery.

To help answer this question, it will help if we first explain what doctors mean when they talk about breast density.

Breast density is a radiologic (mammogram) finding that has nothing to do with how breasts look or feel from the outside. The classification of density has to do with the ratio of fat (not a dense tissue) to everything else that makes up the breast, including glandular and fibrous tissue. On a mammogram, the fat shows up dark and the other stuff shows up white. The more white seen on a mammogram, the more dense the breast classification. The breast density classifications that may be assigned are – from least dense to most dense – the following:

  1. Fatty
  2. Scattered Fibroglandular
  3. Heterogeneously Dense
  4. Extremely Dense

Only about 10 percent of women are categorized as having extremely dense breast tissue. You can learn more about these breast density types, and see images too, at the American Cancer Society.

Here at North Texas Plastic and Reconstructive Surgery, Dr. Slack performs a wide range of cosmetic breast procedures including breast implants, liposuction, breast lifts, and breast reductions. In some cases, he may perform a combination of one or more of these procedures, depending on the goals of the patient. Here is how breast density may come into play with each of these procedures:


Breast implants are placed underneath the breast tissue not within in. This means that the breast tissue itself, no matter how dense, sits on top of the implant and therefore has little bearing on whether a breast implant is possible.


Liposuction alone is sometimes an option for women who are looking for a mild reduction in breast size. It is possible that a woman with extremely dense breasts, which means they have a lower ratio of fat to other tissue, may have a limit as to how much fat can be successfully removed using this method.

Breast Reduction or Lift

A breast reduction or lift sometimes includes liposuction, and the limitation just mentioned may come in to play to some degree. However, because these procedures also include an open surgical component, the goal of the reduction usually isn’t limited by breast density.

Here is the big takeaway: None of these procedures are off limits to a woman simply because she has higher breast density.

There are many factors that will limit a person’s plastic surgery options, including poor health, weight instability, and a bad smoking habit, but breast density usually isn’t one of them. That said, every person who walks into our clinic has their own unique anatomical identity, and that includes breast density. Dr. Slack takes all of this (and more) into consideration when advising each patient and planning their surgery.

If you have more questions about breast density and which breast procedures might be right for you, call our office today and schedule a consultation with Dr. Slack.

The Three Things You Need to Know About Plastic Surgery After Weight Loss

The new year is right around the corner, which for many of us means it’s the time we start thinking about New Year’s resolutions. Perhaps you want to lose weight, stop smoking, or save money. Whatever it is, the new year offers a kind of reset button on life. For some, plastic surgery also offers this opportunity for a reset. Though it can’t fix everything, it can give you the confidence boost to start making other changes.

In this post we will be talking about plastic surgery after weight loss, which is an especially good example of this kind of reset. But, unlike many other changes you might choose to make in the new year, plastic surgery requires an especially large amount of thought, research, and preparation. It’s surgery, after all.

Plastic surgery after weight loss can feel like a huge reset because, for many, it is the last step in a long journey to remake their lives. Losing a large amount of weight (say, 50 to 100 pounds or more) takes time, effort, and in some cases weight-loss surgery. It is arduous, no matter how you get there. Weight loss alone changes lives in a big way, giving people more energy, improved health and self-esteem, and greater mobility. But, like most things in life, it isn’t always a perfect solution.

After significant weight loss, some people are left with excess loose skin. This affects people differently; for some it is a minor cosmetic issue and for others the loose skin itself diminishes mobility, causes rashes and infections, and impacts their sense of wellbeing. This 2018 study of nearly 1200 people (80% were women) who underwent gastric bypass surgery, found a link between excessive skin and poorer psychosocial functioning.

Unfortunately, the loose skin that follows a large loss of weight won’t go away no matter how many sit ups you do or expensive creams you buy. For this reason some people turn to plastic surgery for a permanent solution.

This kind of surgery is generally referred to as body contouring, and it can include a whole host of different procedures including the following:

While these procedures can restore a more youthful and toned appearance to the body, they come with some risk, especially when more procedures are performed at once. For this reason there are three things you need to consider if you are thinking about plastic surgery after massive weight loss.

It’s not an option for everyone

Obesity is a well known health risk and the medical conditions (called co-morbidities) that can go along with it include diabetes, heart disease, stroke, high blood pressure, sleep apnea and other breathing problems. These are serious health issues and they are often the reason someone undertakes an extreme weight loss effort. Sometimes those co-morbidities don’t completely go away, even after a large weight loss, making it too risky to undergo cosmetic surgery.

Plastic surgery for weight loss also won’t be an option for you if you are unwilling to change unhealthy habits. For example, you have to be willing to quit smoking, as it can get in the way of healing.

You have to wait a while after weight loss

Most plastic surgeons will require you to wait at least six months after reaching your goal weight before considering plastic surgery. This gives your body time to stabilize. Many of the health conditions associated with obesity will improve or go away during this time, and good long term eating and exercise habits will get established. This waiting period also gives some of the extra loose skin time to shrink down on its own.

It isn’t a panacea

Plastic surgery is the only permanent way to remove the large amount of loose skin that follows significant weight loss. It can improve your appearance and mobility and even your health. But it will not turn back the clock to a time before you had any weight to lose, to the body you had, say, at 16. Your body will also continue to be subject to the effects of aging after the surgery.

Though there are ways to minimize the appearance of scars, scarring is inevitable as well. (Learn how Dr. Slack keeps scar visibility to a minimum). Take a look at our before and after gallery so you know what to expect, at least in the first months after surgery as scars will continue to fade.

Also, it is important to know that no plastic surgery is a panacea for all of life’s problems; it won’t save your marriage, make you smarter, or get you that promotion. Being realistic and specific about the problems you want to solve will take you a long way toward a more satisfying result.

If you are considering plastic surgery after weight loss, it is important to take your time thinking about it, do your research and find the right surgeon for you. It has taken you a while to get where you are so a little more won’t hurt. Call our office today and make an appointment with Dr. Slack to get that process underway.

Breast Reduction, Breast Lift or Both?

“Location, location, location” is not just a saying in real estate, it can also apply to cosmetic breast surgery. In particular, it is the location of the nipple (further south) that often brings a woman in to see a cosmetic surgeon. As women age, nurse babies, gain and lose weight etc… their breasts change. This is all normal, but some women are unhappy with the stretched skin and sagging that may occur.

This can be true for women with large or small breasts and helps determine whether she chooses a breast lift, either alone or in combination with another cosmetic procedure like an augmentation or a reduction. In our article, Augmentation, Lift or Both?, we discuss breast lifts in the context of breast enlargement. In this article we will discuss breast lifts and breast reductions and why they are often combined.

Breast Lift (Mastopexy)

A breast lift, or mastopexy, is usually done for someone whose nipple is below the breast fold or who has a significant amount of skin below the breast fold. It may also be done to reduce nipple size or for issues with skin irritation under the breast fold.

The procedure involves the removal of excess skin from around the nipple and lower part of the breasts. The nipple may be reduced in size and moved up to a higher position. This can slightly reduce the size of the breast while also decreasing sagging, improving firmness, and giving a more youthful appearance.

Breast Reduction

A breast reduction, or reduction mammaplasty, is a procedure done for women (and men, in fact) who want to reduce the size of their breasts. This may be for cosmetic reasons – perhaps they don’t feel their breasts are in proportion to the rest of their body, or, in the case of men, they want a less feminine appearance. People also pursue breast reduction surgery to alleviate physical symptoms like neck, shoulder, and back pain, headaches, and painful bra strap grooving.

During a breast reduction, breast tissue, including excess fat, skin, and glandular tissue, is removed. The extent of tissue removed depends on the original breast size and the goals of the patient. The surgery includes lifting the breast and repositioning the nipple unless the reduction is done by liposuction alone.

Breast Reduction with Lift

Because larger, heavier breasts are prone to droopiness, a reduction almost always includes a breast lift. According to Dr. Slack, “With any reduction technique, except liposuction-only, the breast is lifted, meaning the droopy lower pole of the breast is elevated so that the breast starts at the breast fold and moves up from there. The nipple/areola complex is elevated along with the breast and is typically made smaller.”

The lift is done for aesthetics, but it is also done for women whose primary complaints are physical symptoms like neck and shoulder pain. This is because the lift and subsequent higher positioning of the breasts significantly improves posture and takes stress off muscles in the neck and shoulders.

While Dr. Slack usually performs a lift with a breast reduction, every case is unique and must be handled individually. You might be looking to downsize but are quite happy with the location of things, or perhaps the reverse. Only a consultation with a highly trained and experienced plastic surgeon like Dr. Slack, will help you understand whether a reduction, lift, or both is right for you. Call and schedule an appointment today.

What if My Teenager Wants to get a Breast Reduction?

Whether you think it is OK or not, the fact remains that adolescents (age 13-19) in the United States are having plastic surgery. More than 200,000 cosmetic procedures are performed on teens per year. Many of these are minimally invasive procedures like laser hair removal or treatments for acne scars, but nearly 70,000 are surgical procedures including breast lifts and breast reductions.

Behind these statistics, though, are the individuals and their parents or guardians involved in making the decision to go forward. No plastic surgery should be taken lightly, but when a teen is involved, there are further considerations. The American Society of Plastic Surgeons gives the following advice:

“As with any surgery, parental consent is required for all plastic surgery procedures performed on teens younger than 18 years old. The ASPS advises parents to evaluate the teenager’s physical and emotional maturity and believes that individual cases merit careful evaluation under the guidance of a plastic surgeon certified by The American Board of Plastic Surgery.”

For breast reductions, called reduction mammaplasty, physical maturity is important in particular. Breast development during adolescence varies greatly and most plastic surgeons recommend waiting until an age when the breasts are fully developed.

Having overly large breasts, or macromastia, can be difficult physically and emotionally. The physical symptoms may include neck and back pain, chronic headaches, rashes, poor posture, and numbness and tingling in the hands. This research study found a significant negative effect on quality of life and eating behaviors in adolescents with macromastia.

The treatment for macromastia is a breast reduction. Depending on breast size, this procedure involves the removal of a variable amount of skin, excess fat and glandular tissue as well as lifting of the breasts so that they do not hang down below the breast fold. This repositioning of the breast may help as much as the actual reduction of the weight of the breasts. 

A 2017 study on the effect of breast reduction on the quality of life in adolescents showed a positive impact. About a hundred teens with macromastia were followed from six months to five years after breast reduction surgery. Along the way they gave the teenagers a self-esteem rating scale, a breast-related symptoms questionnaire, and an eating attitudes test. They found a significant improvement in all three areas that were still demonstrable after 5-years.

According to the American Society of Plastic Surgeons, the best results will occur if the following are true:

  • The teenager initiates the request.
  • The teenager has realistic goals.
  • The teenager has sufficient maturity.

It is important to note that breast reductions are not limited to teenage girls. More than 7,000 breast reductions in boys (age 13-19) with gynecomastia were performed in 2016 alone. Gynecomastia is a term used to describe enlarged breast tissue in men. You can learn more in our post on the surgical treatment for gynecomastia.

You can also learn more about breast reduction surgery in the posts below:

If you or your teenager are unhappy with your breast size, or you simply want to find out if a breast reduction is the right choice, call our office today and schedule a consultation.

Mastopexy in Men: Say Goodbye to Gynecomastia

You might be surprised to learn that one of the fastest growing plastic surgery procedures performed on men in America is… the breast reduction. In 2016, almost 30,000 surgeries of this type were performed on men for a condition called gynecomastia or it’s relative pseudogynecomastia.

Gynecomastia comes from a combination of the Greek words for woman (gynae) and breast (mastos), and it is a term used to describe enlarged breast tissue in men. True gynecomastia is characterized by an overgrowth of glandular tissue. This usually manifests as a small tender lump of glandular breast tissue beneath the nipple/areola. It is not uncommon to see this problem in adolescent males, but in most it will resolve as they get older. Pseudo– (Greek for false) gynecomastia is characterized by increased fat deposits in the breast area.

Both conditions (which for convenience are often both referred to as gynecomastia) are common, affecting up to a third of all men. The problem is benign but can cause social and psychological discomfort.

According to the American Society of Plastic Surgeons, gynecomastia is characterized by the following signs:

  • Excess localized fat
  • Excess glandular tissue development
  • Sometimes excess breast skin
  • Presence unilaterally (one breast) or bilaterally (both breasts)

Though for most cases of gynecomastia there is no identifiable reason for its occurrence, it can be the result of a hormone imbalance: either the presence of too much estrogen or too little testosterone. Drugs including anabolic steroids, certain antidepressants, and alcohol have been linked to this condition as have certain medical conditions, a few of which are listed below:

  • Kidney disease and dialysis
  • Tumor
  • Obesity
  • Extreme stress
  • Hyperthyroidism
  • Liver disease

Depending on the level of physical or social discomfort that accompanies the condition, with the help of a qualified plastic surgeon, the problem can be fixed. Excess skin, fat, and glandular tissue can be removed with a breast reduction, also called reduction mammaplasty.

In many cases this surgery involves a small incision at the border of the areola to remove the offending glandular tissue with any excess fat addressed as needed with liposuction. When the condition is more advanced, it can be corrected with a chest lift, or mastopexy, similar to a breast lift in women.

The severity of the condition, the elasticity of the skin, and the amount of sagging all help to determine the type of mastopexy needed to restore a firmer and more masculine appearance to the chest. The location and extent of the incision depend on the amount of tissue removed and include the following types of mastopexy:

Periareolar or doughnut mastopexy

An incision is made around the areola. Excess skin, fat and glandular tissue are removed. With this technique the areola can be made smaller.

Circumvertical mastopexy

A keyhole incision is made around the areola and down to the crease of the breast in order to remove more excess skin, fat and glandular tissue. The areola can be reduced in size as well.

Extended circumvertical mastopexy

An inverted “T” incision pattern allows the removal of more skin, fat, and glandular tissue and relocation of the areola. In some cases, the vertical scar below the areola is extended out toward the armpit.

To learn how plastic surgeons like Dr. Slack minimize the appearance of scars see our post: Best Practices for Minimizing Scars. You can also look through this male breast reduction before and after photo gallery to see how discrete the scarring can be.

In addition to years of experience, Dr. Slack has completed a fellowship and extensive training in cosmetic and reconstructive surgery of the breast. He says the best candidate for the surgery:

If you are a man suffering from a sagging chest or gynecomastia and want to know if you are a candidate for surgery, contact us today and schedule your consultation.

Augmentation, Lift or Both?

Girl with a choice near the forked road - augmentation lift or both?

Pregnancy, weight fluctuations, and aging – the most normal of life events – can cause changes in a woman’s breasts. Genetics and disease can affect breast appearance, too. Whatever the reason, a woman who is unsatisfied with her breasts may seek cosmetic surgery. She hopes it will help her achieve her goals for her appearance and boost her confidence.

Breast Augmentation

Breast augmentation surgery is the most common plastic surgery procedure in the U.S. This procedure involves placement of saline or silicone implants, or a new type of implant called the Ideal Implant. Breast augmentation offers several benefits including increased size and firmness, more fullness and improved shape, and better symmetry of breasts.

As simple as it may sound to place an implant in the breast, there are actually many variables that affect this surgery. The type of incision and placement of the implant (above or below the muscle) are decisions that will be made specific to your circumstances. There is no single type of breast augmentation that works for every woman, and a good surgeon will customize the procedure according to your own anatomy and goals.

In addition, there are concerns about breast appearance that simply can’t be solved with an implant. Many women seeking augmentation complain of droopiness and sagging of the breast. But in these cases, it isn’t necessarily size that’s the problem. It’s more of an issue of getting everything back where it belongs.

Breast Lift (Mastopexy)

In these circumstances, a breast lift is most likely to offer the desired results. Women whose nipple is below the breast fold or who have a significant amount of skin below the breast fold may feel like an augmentation will improve everything. However, an augmentation alone can make matters worse. The extra weight of the implant will just cause more sagging and stretching of skin.

The breast lift is actually a bit of a breast reduction, in that excess skin is removed from around the nipple and the lower part of the breast. In addition, the nipple is moved up to a more youthful position and is made smaller. The reduction in sagging and improved firmness often provide pleasing results without the need for implants.

Breast Augmentation with Lift

For women who are unhappy with the size of their breasts, lack fullness in the upper part of their breasts, and who have sagging, excess skin, a combination of augmentation and lift may be the right choice.

This combined procedure is a bit more complicated than either procedure alone. The surgeon is tightening skin with the lift, yet stretching it with the implant. There is an art to balancing these procedures, but a skilled surgeon can use them to create excellent results.

Once again, this procedure is not a one-size-fits-all proposition. Choosing an implant, determining how much skin to remove, and placing incisions are all dependent upon your specific circumstances. Sometimes a follow-up surgery to tighten skin after it relaxes around the implant will be required. In some cases the best results are achieved when the two procedures are done at least nine months apart. These decisions must be made based on your individual situation.


Just like everything else about you, your breasts are unique and so are your desires for your appearance. An augmentaiton, lift, or both might provide the results you are looking for. A consultation with a highly trained and experienced plastic surgeon is the best first step to choosing the right path for you.