In short. History, examination and imaging come before any option is discussed, and a new finding redirects the pathway rather than joining it.
Key points
- Volume on each side, fold height on the chest wall, skin quality, the position of the nipple-areola complex and the difference between the sides are recorded rather than remembered.
- Measurements and standardised photographs make a comparison possible at twelve months that a memory cannot, and they are also how a plan is checked against its own starting point.
An assessment of the breast begins before anyone discusses operations, and it follows the same order every time: history, examination, and imaging where it is indicated. Only then is a plan discussed, and the order is not administrative.
History
The history establishes what the breast has been through and what it is at risk of. Family history of breast and ovarian cancer. Previous imaging and what it showed. Pregnancies, breastfeeding and how long ago feeding finished. Weight change, and whether more is planned. Medicines, including hormonal treatment. Smoking. Previous breast operations, and the records of any implant already in place.
Examination
The examination is a comparison rather than a description. The skin is assessed for quality and recoil, the gland for the tissue it carries and any lump within it, the fold for where it sits on the chest wall, and the chest wall for the asymmetry that comes from the ribs. The nipple-areola complex is assessed on the mound, and the armpit is examined. Sensation is recorded, because a record made beforehand allows a later comparison.
Imaging
Imaging is arranged where the history, the examination or your age and background indicate it, and the result is read before a plan is made. A mammogram or an ultrasound taken before an operation also establishes a baseline, which matters for anyone who is going to carry an implant or who has had fat transferred.
What is measured, and why it is written down
Volume on each side, fold height on the chest wall, skin quality, the position of the nipple-areola complex and the difference between the sides are recorded rather than remembered. Measurements and standardised photographs make a comparison possible at twelve months that a memory cannot, and they are also how a plan is checked against its own starting point.
When a finding redirects the pathway
If a lump, a skin change or a discharge is found, the aesthetic question is set aside until the medical one is answered. It is not a judgement about whether an operation is appropriate, but a sequence: a finding that needs treatment should not sit underneath an operation arranged for appearance.
What you should leave with
An explanation of which structure is producing the complaint, what each route would change and what it would leave alone, what the recovery would involve, and what the follow-up is. If imaging or a further appointment is needed first, that is the outcome rather than a way of deferring it.
Findings that stop the aesthetic pathway
- A lump, whether or not it is tender and whether or not it can be moved.
- Skin that has dimpled, puckered or thickened, or a nipple that has newly turned inwards.
- A discharge, or a difference between the sides that has appeared over weeks.
The timing questions that can defer a plan even when nothing is wrong are set out in When Breast Aesthetics Should Wait, and the structures that most often limit what an operation can achieve in The Breast in Layers.
Frequently asked questions
Why does the assessment ask about my family history?
Because it changes when imaging starts and how often it is repeated, and because a strong family history can move the whole question into a breast clinic rather than an aesthetic one. It is also one of the few pieces of information that cannot be obtained by examining you, which is why it is asked at the beginning rather than at the end of an appointment.
Do I need imaging before an aesthetic operation?
Where the history, the examination or your age and background call for it, yes, and it is arranged before a plan is made rather than after. The purpose is to know the breast you are operating on, and a baseline is also useful later, because it gives something to compare a future change against. Whether you need it is a decision made in the appointment, not on a website.
What happens if something is found during the assessment?
The aesthetic conversation stops and the finding is dealt with first. That may mean imaging, a review in a breast clinic, or a sample. It is not a cancellation of your interest in an operation; it is a sequence, and the plan resumes once the finding has been answered. A finding is not a reason to avoid being assessed, and it is one of the reasons to be assessed.
Risks & Limitations
- No breast operation makes the two sides identical, and no result can be promised.
- Scars from breast surgery do not disappear. They soften and fade over a year or more.
- Adding volume does not lift a breast, and a lift does not add volume.
- An implant is not a lifetime device. Removal or replacement at some point is part of the plan, and removal does not restore the shape the breast had before it was placed.
- Fat transfer is partly reabsorbed. A further session is sometimes needed to hold the same volume.
- Nipple and areola sensation may change after an operation, and it does not always return to what it was.
When to Seek Care
- A new lump, or a lump that has changed in size, shape or feel.
- Skin that has dimpled, puckered or thickened, or a nipple that has newly turned inwards.
- A discharge from the nipple, and any discharge that is blood-stained.
- Spreading redness with fever, or a wound that opens after breast surgery.
- A breast implant that becomes firm, tender or different in shape, or a swelling that appears years after it was placed.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.