Breasts come in all shapes and sizes, and women can pursue surgical enhancement of their breasts for reasons of small size or undesirable shape, or both. It is important for me to elucidate during discussion what concerns the patient most, and the surgical approach needs to be tailored accordingly. Two important factors for both the surgeon and patient to consider are: 1. the volume of the breast (cup size) and 2. the position of the nipple (“droopiness”). A breast augmentation with implants alone will primarily achieve an enhancement in volume and may not necessarily achieve a change in the shape of the breast or position of the nipple. To be unaware of this, and to rely on implants alone to improve breast shape and nipple position, may result in disappointment. If the nipple position doesn’t bother the patient greatly, then an augmentation may be all that’s required. Droopiness of the breasts on the other hand, is primarily addressed through a breast lift (mastopexy). There are various techniques that can be applied to the degree of lift that is required; however, all forms of mastopexy require some skin removal and external scarring as a consequence. Even though most scars on the breast will fade over time, scarring can be a major deterrent to having a mastopexy. Food for thought.