BACKGROUND: Our understanding of breast shape and size changes after surgery is limited by a lack of measurement studies that evaluate and compare changes in breast dimensions after cosmetic breast procedures. This study was undertaken to remedy this deficiency. METHODS: Women undergoing primary vertical mastopexy, augmentation/mastopexy, and reduction were evaluated prospectively from 2002 to 2012. Breast augmentation patients were also measured prospectively over a 6-month period during the study. A total of 196 consecutive patients meeting the inclusion criteria-at least 3 months' follow-up and no subsequent breast surgery-were evaluated (inclusion rate, 88.3 percent). RESULTS: Both nipples were located at or above the level of maximum preoperative breast projection in 60 percent of women presenting with ptosis. The maximum preoperative nipple displacement was 6.5 cm. All four procedures increased breast projection and upper pole projection, with a significantly greater boost when implants were combined with mastopexy (p < 0.01). Breast augmentation lowered the lower pole level (p < 0.001) and minimally elevated the breast mound, with no change in nipple level. Vertical mastopexy and reduction elevated the lower pole and breast mound, reduced areola size, and increased the breast parenchymal ratio (p < 0.001). CONCLUSIONS: Vertical mammaplasty corrects glandular sagging and provides a modest increase in breast projection and upper pole projection. Augmentation/mastopexy most effectively treats upper pole deflation and ptosis. In ptosis, the nipple descends primarily with the breast, not on it. Nipple repositioning (<6.5 cm) is preferred over transposition to avoid overelevation and improve safety. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.