What does breast augmentation improve?

Breast augmentation increases breast volume, improves shape, enhances symmetry, restores fullness after pregnancy or weight loss, and helps balance overall body proportions.

What is the difference between saline and silicone implants?

Saline implants are filled with sterile salt water and deflate visibly if they rupture, but they may feel less natural and show more rippling. Silicone gel implants feel more like natural breast tissue and usually have less rippling, but rupture may be silent and monitored with imaging over time.

Are textured implants used in breast augmentation?

Textured implants are used less frequently due to their association with a rare lymphoma called BIA-ALCL. Dr. Freedland primarily uses smooth implants for most patients.

Should implants go over or under the muscle?

Under-the-muscle placement can reduce rippling and capsular contracture risk and often looks more natural in thinner patients, but recovery may be longer. Over-the-muscle placement can have a faster recovery and stronger cleavage, but may show more rippling in patients with thin tissue.

Where are the incisions placed for breast augmentation?

Common incision options include the breast crease (inframammary), around the areola (periareolar), or in the armpit (transaxillary). Dr. Freedland often prefers the breast crease because it gives the best control and heals discreetly.

How is implant size chosen?

Implant size is selected based on your chest width, breast tissue, skin quality, lifestyle, and aesthetic goals. Sizers in a surgical bra help visualize options, and Dr. Freedland recommends sizes that fit safely within your anatomy.

What is recovery like after breast augmentation?

Most patients wear a support bra for several weeks. Discomfort is normal, especially with under-the-muscle placement. Many patients return to work in about a week and avoid heavy lifting or strenuous exercise for 4 to 6 weeks.

Do breast implants last forever?

Implants are durable but not lifetime devices. Many last 10 to 20 years, but future surgery may be needed for rupture, capsular contracture, or cosmetic changes over time.

Why doesn’t Dr. Freedland recommend cosmetic fat injection to the breast?

Fat grafting to the breast can lead to fat necrosis and calcifications that may resemble or obscure breast cancer findings on mammograms. Because cosmetic augmentation is elective, Dr. Freedland avoids introducing long-term screening risks.

Can I still get mammograms with implants?

Yes. Implants do not prevent mammography. Technicians use special imaging views to visualize breast tissue effectively, and you should always tell your imaging center that you have implants.

What are common risks of breast augmentation?

Risks include capsular contracture, implant rupture or deflation, infection, bleeding or fluid collection, scarring, rippling, sensation changes, implant malposition, and the rare risk of BIA-ALCL. Dr. Freedland takes precautions to minimize these risks.

What concerns can labiaplasty address?

Labiaplasty can address discomfort from enlarged or protruding labia, irritation with exercise, difficulty wearing certain clothing, pain with intercourse, hygiene issues, asymmetry, and aesthetic concerns affecting confidence.

What is the difference between wedge excision and trim excision?

Wedge excision removes a V-shaped piece of tissue while preserving the natural labial edge and pigmentation. Trim excision removes tissue along the entire labial edge for maximum reduction but removes the natural border.

Can labia majora also be treated?

Yes. Options include majora reduction for bulkiness, fat grafting to restore volume and smoothness, and limited liposuction in selected cases. Treatment depends on whether the concern is excess tissue, volume loss, or asymmetry.

What is recovery like after labiaplasty?

Swelling, bruising, and discomfort are expected. Most swelling improves in 2–3 weeks. Patients avoid sexual activity, tampons, and strenuous exercise for 6 weeks, with full refinements visible by 6 months.

Is labiaplasty painful?

Most patients describe soreness and pressure rather than sharp pain. Discomfort is usually well-controlled with oral medication for a few days.

Will sensation change after labiaplasty?

Temporary changes in sensation can occur during early healing. Permanent sensation changes are uncommon with wedge techniques and slightly more common with extensive trim excisions.

Can labiaplasty be combined with other procedures?

Yes. Many patients combine labiaplasty with majora reduction, majora fat grafting, clitoral hood contouring, or other body procedures for a single recovery period.

What are the risks of labiaplasty?

Risks include bleeding, infection, wound separation, scarring, over- or under-resection, asymmetry, temporary or rarely permanent sensation changes, and the need for revision.

Why consider labiaplasty?

To address discomfort from excess tissue during daily activities, exercise, or intimacy, and to improve symmetry and proportions for a balanced look.

What is recovery like?

Most patients resume light activities within a few days; full healing typically occurs within a week or two, following aftercare guidance.

Labiaplasty and Labial Rejuvenation Consultation - Freedland MD

We had an extensive discussion about labiaplasty and labial rejuvenation. The external genital area has a wide range of normal anatomy. Some women naturally have larger or more prominent labia, while others develop changes over time from aging, childbirth, weight shifts, or genetics. If your labia cause discomfort, limit daily activities, or create aesthetic concerns that affect confidence, surgery can provide meaningful improvement.

Understanding Labial Anatomy

The external female genitalia include several structures:

Labia majora: the outer, fuller lips made of skin and fat tissue
Labia minora: the inner, thinner lips that extend from the clitoral hood to below the vaginal opening
Clitoral hood: the fold of skin that covers the clitoris

There is tremendous natural variation in labial size, shape, color, and symmetry. Some women have labia minora that extend beyond the labia majora. This is a normal anatomical variant, not an abnormality.

Reasons Women Seek Labiaplasty

Women consider labiaplasty for physical, functional, aesthetic, and emotional reasons. All of these are valid.

Physical Discomfort

Irritation or chafing during exercise, cycling, or horseback riding
Pain or pulling during intercourse
Discomfort wearing tight clothing, swimsuits, or certain underwear
Chronic irritation or inflammation
Hygiene difficulties

Functional Concerns

Interference with tampon insertion or removal
Difficulty with sexual positioning or comfort

Aesthetic Concerns

Self-consciousness about appearance
Asymmetry between sides
Darkened or irregular pigmentation along labial edges
Desire for a look that feels more balanced or youthful

Psychological Impact

Avoidance of intimacy
Reluctance to wear certain clothing
Reduced quality of life or confidence
Anxiety about appearance

Labia Minora Reduction Techniques

There are two primary surgical approaches to labia minora reduction. The right option depends on your anatomy, how much reduction you want, and your priorities for edge appearance and pigmentation.

1. Pie Excision (Wedge Technique)

The pie excision approach removes a V-shaped wedge of tissue from the thickest part of the labium. The remaining edges are sutured together, preserving the natural labial edge.

Advantages:

Preserves the naturally pigmented border for a more natural look
Maintains sensation more reliably by preserving nerve pathways
Creates a smooth, natural contour
Often allows a tension-free closure

Limitations:

More technically complex and requires precise planning
Less reduction possible than rim excision
Leaves a vertical scar on the labial surface (typically heals well)
Not ideal for very thin labia

Best candidates: women with thicker labia minora who want moderate reduction while keeping a natural-appearing edge.

2. Rim Excision (Trim or Linear Technique)

Rim excision removes tissue along the entire free edge of the labia minora. The edge is then sutured to create a shorter labial border.

Advantages:

Provides the maximum reduction possible
More straightforward technique
Good for asymmetry because each side can be adjusted separately
Works well for thin labia where wedge excision is not feasible

Limitations:

Removes the natural pigmented labial edge
Creates a scar along the entire edge (usually heals well)
Can look less natural if too much tissue is removed
Slightly higher risk of altered edge sensation

Best candidates: women needing significant reduction, those with thin labia, or those prioritizing maximum tissue removal over edge preservation.

Labia Majora Rejuvenation Options

Many women have concerns about the labia majora as well. These concerns may include enlargement, deflation, asymmetry, or sagging. There are three main approaches, each suited to a different problem.

1. Labia Majora Reduction

This approach removes excess tissue from overly large or bulky labia majora.

A vertical incision is made along the inner edge of each labium majus
Excess tissue is removed, often about half of the bulk
The remainder is closed for a smaller, smoother outer contour

Best for: women with bulky labia majora that create discomfort or visible bulging in clothing.

2. Fat Injection (Fat Grafting) for Volume Restoration

Fat grafting restores volume when the labia majora have deflated from aging or weight loss.

Fat is harvested from another area using liposuction
The fat is purified and injected evenly into the labia majora
Some fat resorption is expected, often 30 to 50 percent
A touch-up graft may be needed to reach your ideal fullness

Best for: women with flattened, wrinkled, or volume-depleted labia majora who want a fuller, more youthful appearance.

3. Liposuction for Labia Majora Fat Reduction

While liposuction can reduce excess fat, it is rarely my preferred approach in this area.

Important limitations:

The labia majora contain more soft tissue than fat, so liposuction is less effective
It can cause unwanted deflation and an aged look
Internal scarring may create contour irregularities
Results are less predictable and harder to correct if overdone

Best for: select cases with true excess fat and good skin quality, but reduction or fat grafting usually provides more reliable results.

Combined Procedures

Many women benefit from addressing both inner and outer labial concerns at the same time. These procedures can be combined into a single surgery, including:

Labia minora reduction plus labia majora reduction
Labia minora reduction plus fat grafting to labia majora
Clitoral hood reduction when the hood is excessively prominent

Recovery From Labial Surgery

Immediate Post-Operative Period

Swelling, bruising, and discomfort are expected
Ice packs help reduce swelling and improve comfort
Pain medication is typically needed for only a few days
Keep the area clean and dry

Activity Restrictions

No sexual activity for 6 weeks
No strenuous exercise for 4 to 6 weeks
No tampons for 6 weeks, use pads only
Avoid tight clothing early on
No swimming or baths for 2 to 3 weeks, showers are fine

Healing Timeline

Most swelling resolves within 2 to 3 weeks
Subtle swelling continues to improve over 2 to 3 months
Sutures dissolve within 2 to 3 weeks
Final results are visible around 6 months
Scars continue to mature for 12 to 18 months

Setting Realistic Expectations

What Labial Surgery Can Achieve

Reduced size of the labia minora or majora
Improved symmetry
Relief from irritation and activity discomfort
Better comfort in clothing
Restored volume to deflated labia majora with fat grafting
Greater confidence and comfort with intimacy

What Labial Surgery Cannot Do

Create perfect symmetry (some natural asymmetry always remains)
Guarantee a partner’s reaction or improve relationship problems
Match unrealistic media images that are often digitally altered
Prevent normal aging changes over time

The goal is improvement in comfort, function, and appearance, not perfection.

Potential Complications and Risks

Bleeding or hematoma requiring drainage
Infection (rare but requires prompt treatment)
Wound separation during early healing
Visible or thickened scarring (usually heals very well)
Temporary or rarely permanent sensation changes
Residual asymmetry
Over-resection (too much tissue removed, difficult to correct)
Under-resection (inadequate reduction that may need revision)
Fat resorption after grafting that may require a touch-up
Contour irregularities if liposuction is used on labia majora

These risks are uncommon when surgery is done with careful technique and when you follow post-op instructions closely.

Making the Decision

Labiaplasty and labial rejuvenation can provide significant physical and psychological benefits. Key considerations include your personal motivation, technique selection, realistic expectations, recovery commitment, timing around work and life, and your childbearing plans. Take time to think through your goals, review before-and-after photos, and ask questions. This is your decision and your body. My goal is to help you achieve comfortable, natural-appearing results that improve your quality of life and confidence.

Photos were obtained, a quote was given, and the patient will return in a week for further discussions if needed.

Labiaplasty and Labial Rejuvenation Consultation