What are common surgical cosmetic procedures?

Common Surgical Cosmetic Procedures

The most frequently performed surgical cosmetic procedures include liposuction for body contouring, breast augmentation, breast reduction, abdominoplasty, and various reconstructive procedures, with liposuction being the second most common cosmetic surgery in the United States and breast augmentation ranking as the most common overall 1, 2.

Body Contouring Procedures

Liposuction

Liposuction is the primary surgical technique for body contouring and is most commonly performed in patients aged 35-64 years 1. The procedure involves:

• Tumescent technique with local anesthesia as the current standard approach, replacing older methods requiring general anesthesia 3
• Multiple energy-based modalities including laser-assisted, power-assisted, and ultrasound-assisted liposuction 3
• Primary indication is body contouring, not weight loss—this is a critical distinction that must be respected to avoid complications 4

Technical Approach to Body Contouring

Surgeons have five basic surgical procedures available for body contouring 5:

• Pexia (tissue lifting/suspension)
• Dermolipectomy (skin and fat excision)
• Liposuction (fat removal)
• Fat infiltration (fat grafting)
• Implant placement 5

Most patients require combination procedures during the same surgical session to achieve optimal results 5. Abdominoplasty can be combined with liposuction specifically to address loose skin that liposuction alone cannot correct 3.

Breast Procedures

Breast Augmentation

Breast augmentation is the most commonly performed cosmetic surgical procedure in the United States, particularly in women aged 18-34 years 2.

Technical specifications:

• Silicone gel-filled implants are most commonly used, followed by saline-filled implants 2
• Inframammary fold incision is the most common approach 2
• Subglandular placement (under breast tissue but above pectoralis muscle) is the majority approach 2

Key complications to counsel patients about:

• Short-term: asymmetry, seroma, hematoma, infection, changes in nipple sensation 2
• Long-term: implant rupture, capsular contracture, breast implant-associated anaplastic large cell lymphoma 2
• Any breast lump after augmentation requires referral to a breast unit—this could indicate rupture, contracture, seroma, hematoma, cancer, or infection 2

Breast Reduction

Traditional breast reduction surgery with tissue excision remains the standard of care for most patients, as it allows precise glandular tissue removal and skin reshaping 6.

Liposuction-only breast reduction has significant limitations:

• Cannot address skin excess or ptosis (sagging), making it unsuitable for most patients with ptotic breasts 6
• Only appropriate for patients with good skin elasticity 6
• Unpredictable skin retraction and potential for contour irregularities 6
• Limited high-quality evidence supporting its use as a primary technique 6

Breast Reconstruction

Reconstruction options include implant-based procedures, autologous tissue transplantation, or combined approaches, performed either immediately or delayed 7.

For patients requiring post-mastectomy radiation, autologous tissue reconstruction is strongly preferred over tissue expanders/implants due to significantly lower risk of capsular contracture, malposition, poor cosmesis, and implant exposure 7.

Reconstruction techniques include:

• Tissue expander followed by implant placement 8
• Autologous tissue: pedicled TRAM flap, latissimus dorsi flaps, DIEP flap from abdomen 8
• Combined implant and autologous tissue approaches 8

Silicone gel implants are safe and effective for reconstruction 8.

Technical Principles for Optimal Cosmetic Outcomes

Incision Planning

Curvilinear skin incisions following Langer's lines (natural skin tension lines) achieve the best cosmetic results in most breast locations 7, 8.

Critical exceptions:

• At 3 o'clock and 9 o'clock breast positions and lower breast, radial incisions are superior, particularly when skin removal is necessary 7, 8
• Periareolar incisions are inappropriate for peripheral breast lesions 8

Closure Technique

• Skin should be closed with subcuticular technique 7, 8
• Preserve subcutaneous tissue with separate closure to improve cosmetic outcomes 7, 8
• Avoid reapproximating breast tissue in a manner that appears adequate supine but causes distortion when upright 7

Critical Technical Points

Meticulous hemostasis is critically important—hematoma formation complicates postoperative evaluation, makes mammography interpretation difficult, and can lead to unnecessary biopsies due to evolving scar tissue 8, 7.

Nonsurgical Alternatives

For body contouring without surgery, options include 3:

• Cryolipolysis (cold-induced fat destruction)
• Radiofrequency lipolysis devices (heat-based)
• Low-intensity ultrasonography (mechanical fat cell destruction)
• High-intensity focused ultrasound (thermal methods)

These can be performed alone or combined with surgical procedures 3.