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Breast Enhancement: The Pros & Cons of Surgery

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  • Breast Enhancement: The Pros & Cons of Surgery

    Breast Enhancement:

    More Women “Next Door” are Seeking Augmentation—The Pros & Cons of Surgery

    By Dan Gwartney, MD


    Despite the efforts of every fashion designer, beautician and cosmetics mogul, nearly everyone finds an unflattering physical flaw in their appearance— whether put there because of genetics, environment, age or accident. In such situations, the option of cosmetic surgery always comes up.


    It’s not surprising that members of affluent societies are concerned with appearance and seek out information on looking good, presumably to feel better and interact more positively with society. Means of improving appearance can include clothing, hairstyles, makeup, dieting, exercising and pharmaceutical enhancement (i.e., Botox and/or plastic surgery). Most of the these options deal with the overall “package” without addressing the underlying person behind the appearance. While this may seem outwardly vein and superficial, how you look on the outside can and does affect how you feel on the inside. Consider the difference a great hairstyle makes versus a “bad hair day.”

    Despite the efforts of every fashion designer, beautician and cosmetics mogul, nearly everyone finds an unflattering physical flaw in their appearance— whether put there because of genetics, environment, age or accident. In such situations, the option of cosmetic surgery always comes up.

    The Choices You Face

    Cosmetic surgery, also referred to as aesthetic surgery, is a branch of plastic surgery. Plastic surgeons are specialists who undergo additional training (usually seven years of training after graduating from medical school) to learn and master the procedures and techniques used to restore or enhance a person’s appearance and function.

    Though most people think of extreme makeovers or celebrity beauty boutiques when they think of plastic surgery, the practice also includes reconstructive surgery to treat people who suffer from serious trauma, birth defects, burns or those who need surgical repair – such as women who have undergone mastectomy to remove a cancerous breast. The Yellow Pages offerings for cosmetic or aesthetic surgeons has expanded along with the availability of Botox treatments, dermabrasion, liposuction and similar processes. Because of this, it’s critical that the consumer (patient) scrutinize a doctor’s qualifications before agreeing to allow him/her to perform a treatment.

    Fortunately, most surgical cosmetic procedures remain in the realm of plastic surgeons, the majority of whom are highly skilled. It’s important that when evaluating a plastic surgeon, you ensure that he or she is board certified in plastic surgery, has experience in the procedure you’re considering and is willing to listen to you and communicate their plan in a manner you understand.1 Most plastic surgeons will have before-and-after photos to share, but these really hold little value other than offering reassurance that other people have benefited from the choice you’re facing.

    According to the American Society of Aesthetic Plastic Surgery, the most common cosmetic procedures performed on women in the United States in 2005 were: lipoplasty (liposuction), breast augmentation, blepharoplasty (eyelids), abdominoplasty (tummy tuck) and breast lift.2 Four of the five procedures are reflective of the demographics of the United States, as obesity and aging create demand for procedures such as liposuction, tummy tucks, eyelid and breast lifts. Breast augmentation— the second most common surgery with 364,610 procedures performed in 2005— stands out as the most purely cosmetic of the group.

    This number, up 9 percent from 2004 and 37 percent from 2000, stands as a testament to the demand from American women for larger or more shapely breasts.2,3 Even after subtracting the women who received breast implants for reconstruction after cancer surgery (approximately 20 percent), there were still nearly 300,000 women who underwent the procedure solely for cosmetic reasons.4 This, despite several strong disincentives working against choosing to undergo augmentation, including emotional, social, financial and clinical arguments that each woman must face.

    Who Chooses Breast Implants?

    Before looking at the individual factors that weigh in on the decision, it’s interesting to note the demographics of women who undergo cosmetic breast augmentation. For decades, mentioning the word “implants” brought to mind adult movie actresses, exotic dancers and entertainment celebrities. These examples were often extreme, displayed in a blatant manner and publicly criticized in the media. The topic of cosmetic breast augmentation was tainted by an association with pornography and a generalized discomfort with implied sexuality.5,6 Contrast that with current trends: according to data obtained in 2003 in a survey funded by the Aesthetic Surgery Education and Research Foundation, three-fourths of the respondents were married or in a long-term relationship, with nearly half having received a bachelor’s degree. The median age was 34.7 These statistics are a stark contrast to the longstanding perception that only promiscuous women barely out of their teens choose the procedure.

    According to an article by Rita Rubin in USA Today, the primary reason most women choose to enhance the bust is self-image.3 Mental or emotional health is dependent to a large degree on self-esteem and body image.8,9 Though some people, both male and female, have distorted perceptions of body image (a condition called body dysmorphic disorder or BDD), most people are realistic in critiquing their own bodies.10 Contrary to the belief that women undergo breast augmentation to become more attractive to men, most women make the choice because they believe the implants will correct body proportions, improve the fit of clothes, expand wardrobe options and enhance self-esteem. Indeed, improved self-esteem is reported by the vast majority of implant recipients.11

    The average bra size for adult women in the United States is difficult to state with accuracy, but the following statistics are commonly offered, presumably based on the marketing data of major bra manufacturers.12 The average breast size in the United States— formerly 34B in 1996— is now 36C; breasts in England also increased from 1997 to 1999 from 36B to 36C. In Asia, the increase from 1980 to 2000 was from 34A to 34C. The change is believed to be the result of several possible factors, including sizing by manufacturers, generalized obesity and of course, implants. Another interesting statistical set declared the following to be the cup size distribution in America: AA— 2 percent, A— 15 percent, B— 44 percent, C— 28 percent, D— 10 percent, and DD— 1 percent.12 Of course, these data suggest the average cup size is B, so it conflicts with the earlier findings.

    The Myth of the Breast

    Though many people, male and female, are quite vocal in their opposition to cosmetic surgery in general and breast augmentation specifically, the positive emotional impact this procedure has for many recipients is dramatic.11 Opponents often base their arguments on religious or cultural bias, their view being that people shouldn’t alter their “natural” appearance. Many is the time I’ve heard disparaging comments between nonaugmented women about another woman with implants, whether it be at a health club, restaurant or sports event. Curiously, some of these same women later undergo augmentation or inquire about the procedure. The rivalry that exists between women is explored by author Phyllis Chesler as she discusses her findings in studying cruelty between women in her book Woman’s Inhumanity to Woman.13

    Yet, putting aside group opinions and dogma, each individual represents an entirely unique case. Certainly, there are some people who choose breast augmentation to appeal to men, to pull attention away from other women or for other shallow, ill-considered reasons. However, the majority of cases involve women who have long considered their breasts too small, asymmetrical (different sized) or deformed by age, extreme weight loss or breast-feeding— even exercise.8,9,14,15 Anyone voicing ridicule or scorning a woman who has undergone breast augmentation truly needs to walk a mile in her shoes to understand her motivations. Of course, the shrill harpies could also mind their own business, but that’s unlikely to happen.

    Men, of course, are very aware of breasts. In testosterone-laden environments, conversation is hushed and every XY eye locks in on the bust of any well-endowed woman who enters the scene, though an equally attractive but flat-chested woman may pass by with barely a glance. Artists and advertisers have been cognizant of this fact for centuries. Exposed breasts have long been used in paintings and sculptures to depict women’s sexuality, often presenting women as objects of men’s (or gods’) lust or violence, as discussed in a series of essays in the book Naked Truths: Women, Sexuality & Gender in Classical Art & Archaeology. Fantasy artists Frank Frazetta and Boris Vallejo escalated the sale of pulp fiction with their depictions of scantily clad, large-busted women clinging to muscular warriors. Hugh Hefner became a household name in the 1950s and beyond by publishing photos of nude women in his magazine Playboy.16,17 It’s only fair to note that many fashion magazines and romance novels marketed to women utilize the same hook, such as the “Fabio” covers showing the muscular Italian model embracing gowned damsels with ample cleavage.

    While there’s no general consensus on the “ideal” breasts by men or women, it’s clear from advertising that a prominent, well-supported bosom that doesn’t show the ravages of time is the accepted standard. Judging by fashion magazine covers, the public appears to be drawn to C- or D-cup breasts on women with youthful skin and relatively low body fat. Of course, this isn’t realistic for most women, particularly those who have passed their 30th birthdays. Assuming the data presented by the bra manufacturers is correct, 61 percent of women have a B cup or smaller.12 Further, very few women have the “Barbie doll” proportions that would make a C- or D-cup breast appear proportionately large. Women who do have naturally large breasts often suffer from body changes that occur with time, pregnancy, exercise and gravity. Clearly, the discrepancy between real and ideal add to the pressure to consider breast augmentation.

    Emotionally, there are strong pulls both for and against breast augmentation. An improved body image, better self-esteem and finer appearance in and out of clothes is weighed against the scrutiny and criticism of opponents and the pre-existing association of promiscuity and pornography.

    The Social Perils of Breast Augmentation

    Social matters often factor into a woman’s decision to inquire about breast augmentation. Early experiences of being mistaken for a boy, dumped for a busty tart, feeling inadequate in a bikini or tight-fitting top or a cruel comment in an intimate situation can cause lasting emotional distress.18 As Phyllis Chesler mentions in her book, rivalries between women lead to constant comparisons. In casual settings, men tend to pay more attention to women who display their sexuality to a greater degree and breast development is one signal imprinted into the most primitive part of a man’s brain. In intimate settings, a woman’s confidence in her appearance and appeal affects the experience for both partners.

    Even though these situations can be empathetically understood, breast enhancement can also lead to uncomfortable or even threatening social situations. Referring back to the work of Phyllis Chesler, a shapelier woman— particularly one who appears more youthful and sexually capable— is a threat.13 Many women have commented that after undergoing breast augmentation, other women are less friendly, and even strangers (female) will scoff or sneer at them without any prior interaction. Couples may be threatened by the approach of a busty woman, causing the man to be equally unfriendly; social or business opportunities may be withdrawn. Of course, other opportunities are often opened, so it’s definitely a situation of compromise. Some men, strangers and acquaintances, may respond inappropriately, even lewdly, to a pronounced change in appearance.

    While it’s entirely possible— even likely— that many formerly flat-chested women might receive more date offers, it’s not necessarily true that the quality of the dates will improve. While the single woman may benefit from a greater number of candidates to choose from, some have reported that conversations and relationships are more difficult, as men focus less on the person and more on the breasts and the implications of sexuality. More than one woman has commented that she misses relying on her wit and humor in dating situations.

    The situation appears to be different for married women and those in long-term relationships. In this setting, an emotional commitment exists between the partners, with the spouse being aware of the woman’s desire to change a physical “flaw” that’s bothered her for years. Sometimes, it’s restoring the appearance of the breasts after pregnancies and breast-feeding. Other times, it’s correcting an asymmetry that has long been covered with pads or simply lived with. And yet in others, it may be a reward when the couple has reached a point where the procedure is within their means. Surprisingly, it’s often the spouse or partner that needs more convincing about the procedure.3 This may be a reflection of the lessened sense of need by the partner in a mature relationship or a lack of understanding about the controversy that has surrounded breast implants.

    Clinical & Health Aspects

    Breast implants aren’t cheap. Typically, the costs of the initial procedure ranges from $6,000 to $10,000.3 Additionally, a small percentage of women need follow-up surgeries to correct placement or remove the implants if a capsule forms and causes pain or disfigurement.19 Also, the lifespan of an implant is variable, but it may need to be replaced or removed eventually. As insurance doesn’t cover cosmetic breast augmentation (or any follow-up treatment) this places the surgery beyond the means of many women. Perhaps this factor, as much as any other, is responsible for the demographics reported in the earlier survey. Most women or couples don’t have sufficient disposable income to afford such a procedure until they’re more established. However, there are still a number of young women who are using credit cards, loans or payment plans to have the surgery.

    The emotional, social and financial considerations involved with deciding on breast augmentation are difficult enough, but an even more weighty issue is also associated with the decision— the clinical and health aspect.

    Silicone breast implants were pioneered in the 1962; earlier techniques for augmenting the breast size included injecting paraffin wax or silicone directly into the breast.20 The greater safety and better cosmetic results offered by early silicone implants caused their popularity to steadily climb. The most common form of implant used was the silicone implant, which was considered to be aesthetically pleasing and safe. Silicone is used in many medical devices as it’s considered to be biologically inert. In other words, the body doesn’t react to it. This is disputed as the body does appear to react to certain forms of silicone.21,22 However, a trend developed in which women who had received the silicone implants began to report the onset of connective tissue diseases, such as lupus or rheumatoid arthritis.23,24 In certain cases, the symptoms were reported to go away after the implants were removed, suggesting that the implants were the cause. It was discovered that many of these implants had leaked, allowing some of the silicone to enter the tissue around the implants and even get into the lymph nodes.

    Based on these findings, a number of lawsuits were initiated against the implant manufacturers.25 The number of cases grew quickly, leading to a class action lawsuit that drove most of the manufacturers out of the silicone implant business and threw large corporations into bankruptcy. However, many, many reviews of the data and follow-ups of women who retained their implants failed to show any evidence proving an association between silicone breast implants and the reported diseases.25-27 In fact, the National Cancer Institute reports that women with implants are 50 percent to 60 percent less likely to be diagnosed with breast cancer.4 Rather than immediately attributing a protective property to the implants, it has been previously reported that women with smaller breasts have a lower incidence of breast cancer, possibly explaining the finding.28

    Fourteen years after being pulled from the market, silicone breast implants have again been approved for use in cosmetic procedures.29 Between 1992, when the moratorium was issued, to November 2006, silicone implants could only be used to correct asymmetry or post-mastectomy repair. A small number of women received silicone implants as part of the studies involved in the recent Food and Drug Administration (FDA) approvals. Interestingly, during the time of dispute, silicone implants were still being provided to women who had already developed cancer, possibly the most vulnerable group because of their already challenged health.

    Breast Implant Safety: A Little History

    Prior to receiving FDA approval, Allergan and Mentor, the two companies currently approved to market silicone breast implants for cosmetic augmentation, completed studies of approximately four years duration.29,30 Based on the previous findings from the numerous reviews that were performed during the silicone hiatus and the companies’ clinical trials, the FDA found that the companies had proven they could be “reasonably certain” that the silicone implants are safe. However, opponents have been quick to contest the issue, claiming there’s no long-term safety data and accused the FDA of rushing the decision.31,32 It’s unclear what further burden of proof opponents desire, as silicone breast implants have been in use for nearly four decades and are among the most closely studied medical devices ever marketed.

    Shortly after the FDA approval was announced, an Austrian study made headlines.33 This study investigated the deposition of proteins on implants removed from women, as well as implants incubated in the laboratory, in an environment that closely resembles human tissue. It was discovered that a number of previously unidentified proteins adhere (or stick) to implants, particularly in women who have retained their implants for longer than five years. Among these were a small number of proteins that might initiate an autoimmune response. In other words, the researchers believe they identified proteins formed by the body in reaction to the implants that might lead to the diseases women had reported during the 1980s and early 1990s. The timing of the study’s release is curious in that it was released just four days after the implants were approved. The lead author, Aleksandar Backovic, equivocates in the conclusion of the study, stating, “The causative relationship between autoimmune disease development and silicone implants is still a matter of debate. This paper cannot yet resolve this issue…”33 Yet, in an interview with WebMD.com, Backovic states more strongly, “We believe this is at least one of the causes of the immune system problems that have been attributed to silicone implants.”34

    This comment is contested by plastic surgeon and past president for the American Society for Plastic and Reconstructive Surgeons, Bruce Campbell, MD. In the same article, he states, “The fact is that proteins attach to all kinds of biomedical devices implanted in the body. But it’s a huge leap of faith to reach the conclusion that the presence of these proteins is responsible for triggering these autoimmune phenomena.” In addition, he adds, “The FDA just approved these devices, after studying the data for the last 14 years. If they thought for a moment there was a valid concern about connective tissue disease— or any disease— they would never have done that."34

    The picture is further muddied by allegations of a cover-up by industry whistle-blowers. A New York Times article, printed May 22, 2005, revealed the allegations of two former employees of Mentor who claimed that safety data showed silicone breast implants leaked more commonly than reported and that the platinum contained in the implants is more dangerous than stated.35

    Prior to the November 17, 2006 approval to allow silicone breast implants back into the market for cosmetic use, women had the sole option of saline implants. Saline implants contain saltwater rather than silicone and are considered by nearly all to be “safe.” Saline doesn’t have any known potential to cause disease; it’s the same basic fluid that’s put into IV bags, which is infused directly into the bloodstream. If a saline implant leaks, it’s immediately apparent as the implant will rapidly deflate, whereas silicone will tend to stay in the general area of the implant and the breast’s appearance won’t be noticeably affected.

    It’s the leaked silicone that most concerns people. Silicone has been found in nearby fat and breast tissue, as well as regional lymph nodes.36,37 However, no elevation in the blood levels of silicone or platinum have been reported.38 Perhaps more importantly, breast milk doesn’t appear to be contaminated by silicone. One study compared the silicone content of breast-feeding women with implants, compared to those who had never had implants, and also compared cow’s milk and infant formula. The breast milk of the two groups was very similar, and there was no increase in silicone in the breast milk of women with implants. However, a much higher value was detected in both cow’s milk and infant formula.38

    “Do I Have My Breast Augmented”

    Given the controversy regarding safety with silicone breast implants, why would a woman choose to get them? The primary reason is that silicone implants have a more “natural” feel. Saline is simply saltwater, whereas silicone is a viscous fluid with a more gelatinous structure. To gain a rough impression of the difference, take a Ziploc bag and fill it three-fourths full of water and then fill another three-fourths full with jello. Let the gelatin form overnight in the refrigerator and then compare the two bags by feeling them. Squeeze the bags, poke them with a finger, set them on the counter; the gelatin bag likely feels more like a breast (remember, this is a very rough example). Now, fill another bag completely full of water and compare the three. The turgid, full bag of water has more structure and feels kind of like a breast and is certainly an improvement to the limp, partially filled bag. However, when compared to the gelatin, the full water bag is more rigid and when set on the counter, its shape is more prominent and noticeable. If so inclined, one could even hold the two bags (full water and gelatin) against the chest and feel the relative difference.

    Silicone does have a more “natural” feel, accounting for its popularity prior to the 1992 withdrawal. In Europe, where the safety of silicone has never been questioned, more than 90 percent of breast implants are silicone.29

    The questions facing women now isn’t only, “Do I have my breasts augmented?” but also “What type of implant do I use?” Undoubtedly, there are advantages and disadvantages to both. Saline is less controversial and a leak would be immediately detected and corrected (by having the implant replaced) without any concern for subsequent health risks. Silicone is more natural in appearance and feel, but are there health risks associated with the silicone implants? Certainly, the FDA hasn’t done much in alleviating the concerns of women, as they recommend (but don’t require) that women have screening MRIs (a type of scan) every two to three years and removal if a leak is detected, even if it doesn’t affect the aesthetics of the breast.39 This recommendation would greatly increase the cost of having implants, as the MRI scans are estimated to cost over $1,000 and replacement or removal of the implants would be cost-prohibitive to many women. Further, the FDA is requiring both companies, Allergan and Mentor, to conduct post-approval studies on 40,000 recipients of silicone breast implants. These actions by the FDA certainly don’t provide much comfort.

    Many plastic surgeons have reported great interest from women anticipating the availability of silicone implants, with some offices establishing waiting lists. The availability of silicone implants is expected to drive demand for breast augmentation procedures to even greater levels. However, there are also some women who are taking a “wait and see” approach to see what develops over the next year or so. As soon as data becomes available from the early recipients of the current generation of silicone breast implants, a greater degree of certainty may be gained. Further, companies are working on the next generation of silicone implants, using a more viscous material; these implants are being called “gummy bear” implants.39 The gummy implants are reported to be even more resistant to leakage. In addition to improving the quality of the silicone gel, manufacturers have also improved the shell, using thicker material and adding separate layers in the implants. Dr. Garry Brody, clinical professor of plastic surgery at the University of Southern California School of Medicine believes these improvements are substantial. In a letter to The Los Angeles Times, he states the oft-claimed 10-year lifespan of a breast implant is based on the experiences with the thin-shelled, 1970s-style implant. Current generation implants are significantly stronger and more durable; they have an indefinite life expectancy.40

    An excellent article titled, “An Implant Patient’s Primer” by R.J Ignelzi was published in the San Diego Union-Tribune, December 26, 2006.41 This article was accessible through the newspaper’s website at http://www.signonsandiego.com at the time of this writing. In it, Ignelzi follows the process one woman followed in making her decision and then offers advice on how to choose a surgeon and possible consequences that need to be considered.

    Breast Specifics: What to Choose

    If, after considering all the pros and cons a woman chooses breast augmentation, the next critical but rarely discussed question is how big a woman wants her implants. Unfortunately, this is somewhat like picking a hairstyle. Many women will come in with a magazine photo and say “I want Angelina Jolie’s breasts.” Unfortunately, so many factors come into play affecting the outcome of an augmentation that the results can never be guaranteed. In fact, it’s difficult to state with absolute certainty what bra size a particular implant will provide.

    The implant’s appearance depends on the type used, the size of the implant, the shape, where it’s inserted, as well as the patient’s rib cage, overlying breast tissue, skin condition, body composition, health and adherence to post-operative care.42

    As mentioned earlier, saline implants are more turgid. Though silicone implants will fall to gravity more easily when lying on your back or side, saline implants tend to hold one position. This is particularly true during the first months to a year until the surrounding skin relaxes. Also, for very lean women with small breasts, the saline implants may show folds or wrinkles.43

    Desired breast size is a personal choice. Many women immediately state “C cup” as this has long been the accepted standard. This shouldn’t be a reflexive response, particularly if proportions or a particular result are the end goals. Of the relatively few women who have been very conservative I have spoken with (asking for a B cup, or perhaps just a one cup size change), nearly all wish they would have been more aggressive. Conversely, an increase of more than three cup sizes or an end result larger than a DD cup often results in a prolonged recovery, pain, an imbalance in proportions, or a outcome that doesn’t meet the expected aesthetics or creates social concerns. Overly large implants carry a greater risk of affecting breast and nipple sensation, with up to 15 percent of women reporting a permanent loss of sensation in some areas of the augmented breast, depending on procedure and implant size.44 This should be thoroughly discussed during your first consultation with the plastic surgeon.

    Initially, the only choice in implant shape was a disc-shaped implant that didn’t appear natural, particularly in lean women with small breasts. Now, more anatomically designed shapes are available. The teardrop-shaped implant has been in use for over 10 years and provides a very appealing result.

    Implants may be inserted under the breast tissue or under the muscles of the chest. There are advantages and disadvantages to both that need to be discussed with your plastic surgeon.45 Many athletic women have noted that implants under the muscle affect upper body strength.

    Women with broad rib cages tend to do better with larger implants, as the smaller implants often appear too narrow on their chest. Conversely, women with a narrow rib cage tend to find that the larger implants may extend too far on the side. This can affect nipple location, so it’s an important aspect to consider.

    Implants aren’t only placed in small-breasted women, but also women who’ve lost breast size or whose breasts sag due to weight loss, breast-feeding or age. In these cases, a second procedure is often performed at the same time called a “mastopexy” that removes some excess tissue and tightens up the breast, restoring the “perky” appearance.46 Women with a fair to generous amount of breast tissue can accommodate saline implants more readily. They can also augment their breasts to a larger size with a more natural appearance.

    What Enhanced Breasts Can’t Do

    The breast is more than a silhouette or a shape under a sweater. It’s a surface feature whose appearance is affected by the condition of the overlying skin.42 Many women suffer from stretch marks brought on by rapid growth during puberty, pregnancy or obesity. Aging, exacerbated by excess sun exposure or poor nutrition, can be detrimental; tattoos and scars due to injury or surgery can affect the appearance of the breasts. Some of these can be corrected during an augmentation procedure, others can be dealt with prior to or following the surgery, and some may not be repairable. Again, any concerns should be discussed with your plastic surgeon prior to committing to augmentation.

    Breast augmentation may correct proportions, particularly in bottom-heavy women, but it doesn’t improve fitness or body composition. A significant percentage of elite-level fitness competitors and models have breast implants, providing them with a comic book, super-heroine appearance. However, the impressive outcome demonstrated by these women is as dependent on their underlying condition and leanness as much as their enhanced bustiness. Supermodel Anna Nicole Smith likely had larger breasts during her MTV reality show days as she does in her recent diet product ads, yet her breasts are much more apparent in pictures revealing her newly slenderized self. Like any other cosmetic surgical procedure, breast augmentation only addresses one factor in a person’s appearance. The remainder is the patient’s responsibility.

    Lastly, it’s critical to follow the directions for post-operative care suggested by your surgeon. Many surgeons now recommend a vigorous massage of newly inserted implants to open up the pocket in which they’re placed.47 Failure to do so may result in improper placement, unnatural positioning or (lack of) movement, as well as long-term discomfort. Initially, the exercises will be uncomfortable, often requiring the use of a painkiller in the first week or two as the swelling and novelty of the implants makes any manipulation uncomfortable. Eventually, the implants will settle in and rest comfortably in a natural position, providing more appealing results.

    Weigh the Pros & Cons Before Committing

    The length of this article should suggest how much there is to think about when the option of undergoing breast augmentation is being considered. Though every woman is a unique person with her own motivations and desires, everyone should consider the various aspects involved in this cosmetic procedure. There are emotional, social, financial and health pros and cons. This makes it vital that one become well-informed and self-educated prior to meeting with a well-qualified plastic surgeon. If augmentation is right for you, deciding on the proper implant is a matter that should be approached with equal forethought.

    Many women have experienced very positive, quality-of-life changes after undergoing breast augmentation, but there have also been some who experienced complications. Though there remains a great deal of controversy over the safety of silicone implants, many conclusive studies and meta-analyses find no health risks associated with these devices as were reported during the late 1980s and 1990s. Silicone implants have always been available in Europe and are used in over 90 percent of augmentations. The FDA has required that Allergan and Mentor conduct a follow-up of 40,000 patients receiving the newly approved implants, so in a few year’s time, the picture should become clearer. Improvements have been made to silicone implants, with “gummy bear” implants scheduled to be available in the next year or two, promoting greater resistance to leakage. Unfortunately, at this time, it’s impossible to state unequivocally that silicone implants are safe.

    There are many pressures on both sides of the issue regarding breast augmentation. Not only do personal discomforts and dissatisfactions factor in, but so too do society’s expectations, spousal/partner response and health questions. There are even large-breasted mannequins now being marketed to bring the issue to the mind (and eye) of every person walking by certain chic fashion stores.48 As with any personal decision, the best choice involves an informed decision that ultimately is based on your needs and desires. Cosmetic issues will always be controversial, particularly as biotechnology and medicine expand the choices being offered. Even for breast augmentation, the ceiling for controversy hasn’t been reached as recent discoveries are suggesting stem cells could be used for cosmetic applications, including breast augmentation.49 Remember, this procedure is a choice, not a treatment. There’s no rush and it’s better to be patient and sure than to act prematurely, before a level of comfort and certainty is reached.

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    • Price JM, Rosenberg ES. The silicone gel breast implant controversy: the rise of expert panels and the fall of junk science. J R Soc Med, 2000;93:31-4.
    • Janowsky EC, Kupper LL, et al. Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med, 2000;342:781-90.
    • Lipworth L, Tarone RE, et al. Silicone breast implants and connective tissue disease: an updated review of the epidemiologic evidence. Ann Plast Surg, 2004;52:598-601.
    • Hsieh CC, Trichopoulos D. Breast size, handedness and breast cancer risk. Eur J Cancer, 1991;27:131-135.
    • Rundle RL, Mathews AW. Breast implants made of silicone win FDA backing. The Wall Street Journal, 2006 November 18:A1,5.
    • FDA approves silicone gel-filled breast implants after in-depth evaluation: agency requiring 10 years of patient follow-up. FDA News, 2006 November 17. Available at http://www.fda.gov/bbs/topics/NEWS/2006/NEW01512.html accessed January 17, 2007.
    • Silicone Breast Implants. National Women’s Health Network. Available at http://www.nwhn.org/silicone_breast_implants accessed January 17, 2007.
    • Melmed E. Silicone implants – they’re still dangerous. Los Angeles Times 2007 January 3. Available at http://www.latimes.com/news/printedi...news-a_section accessed January 17, 2007.
    • Backovic A, Huang HL, et al. Identification and dynamics of proteins adhering to the surface of medical silicones in vivo and in vitro. J Proteome Res, 2006 November 21;[Epub].
    • Boyles S. Silicone breast implants: new concerns. WebMD Medical News 2006 December 18. Available at http://www.webmd.com/content/Article/130/117838.htm accessed January 17, 2007.
    • Harris G. Maker of silicone breast implants hid defects, workers said. The New York Times, 2005 May 22.
    • Peters W, Smith D, et al. Silicon assays in women with and without silicone gel breast implants – a review. Ann Plast Surg, 1999;43:324-30.
    • Flassbeck D, Pfleiderer B, et al. Determination of siloxanes, silicon, and platinum in tissues of women with silicone gel-filled implants. Anal Bioanal Chem, 2003;375:356-62.
    • Semple JL, Lugowski SJ, et al. Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measure for silicone. Plast Reconstr Surg, 1998;102:528-33.
    • Breast implant questions and answers (2006). U.S. Food and Drug Administration Center for Devices and Radiological Health. Available at http://www.fda.gov/cdrh/breastimplants/qa2006.html accessed January, 17 2007.
    • Brody GS. Reports support breast surgery. Los Angeles Times 2007 January 7. Available at http://www.latimes.com/news/opinion/...sunday-letters accessed January 17, 2007.
    • Ignelzi RJ. An implant patient’s primer. San Diego Union Tribune 2006 december 26. Available at http://www.signonsandiego.com/news/h...c26implan.html accessed January 17, 2007.
    • Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg, 2002;109:1396-409.
    • Stokes RB. Breast augmentation in thin women: patient satisfaction with saline-filled implants. Aesth Plast Surg, 2004;28:153-7.
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    • Field DA, Miller S. Cosmetic Breast Surgery. Am Fam Physician, 1992;45:711-9.
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    "The only lack or limitation is in your own mind."

    MD!!!

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  • #2
    Dr. Blau's BEFORE and AFTER PICS
    Attached Files

    Comment


    • #3
      You might think this is a joke, but I have a separate savings account that I'm using as a breast implant fund.

      Yes, I might be poor as heck, but I know how to manage money. I throw a little aside every once in a while and I'm about halfway there.

      Then, she's getting a nice christmas present!

      Comment


      • #4
        Originally posted by darkdan View Post
        You might think this is a joke, but I have a separate savings account that I'm using as a breast implant fund.

        Yes, I might be poor as heck, but I know how to manage money. I throw a little aside every once in a while and I'm about halfway there.

        Then, she's getting a nice christmas present!
        \

        didn't you mean "WE'RE" getting a nice christmas present?
        www.MelissaDettwiller.com

        www.physiqueboutique.com

        Comment


        • #5
          90% of the women who get them do not look good. Probably the most abused an un needed form of Plastic surgery for women in America.

          Comment


          • #6
            I would actually for once say I agree with Bateman. I mean there are some exceptions but a lot of them don't look good.

            Comment


            • #7
              Originally posted by melissa View Post
              \

              didn't you mean "WE'RE" getting a nice christmas present?
              I couldn't care less either way. I'm a butt man myself.

              But she's self conscious about it. 32a and all.

              Comment


              • #8
                Originally posted by darkdan View Post
                You might think this is a joke, but I have a separate savings account that I'm using as a breast implant fund.

                Yes, I might be poor as heck, but I know how to manage money. I throw a little aside every once in a while and I'm about halfway there.

                Then, she's getting a nice christmas present!
                darkdan LOOK AT THIS FILM .IT IS JUST A FUN ONE:

                http://www.bordergatewayprotocol.net...masBoobies.swf
                Last edited by Dave P; April 20th, 2007, 01:50 AM.
                Award winning sculptor and painter.
                Dr. Blau is a Board Certified Plastic Surgeon &
                A Diplomat of the American Board of Plastic Surgeons.
                http://www.cosmetic-md.com
                http://www.gynecomastia-md.com

                914-428-4700

                Comment


                • #9
                  HAHAHA!

                  It's the gift that keeps on giving.

                  Comment


                  • #10
                    Originally posted by darkdan View Post
                    I couldn't care less either way. I'm a butt man myself.

                    But she's self conscious about it. 32a and all.
                    '
                    i feel ya'....i'm kinda partial to female butts myself, lol! but at least she will feel better about herself and THAT will be good for you as wel.....TRUST ME!
                    www.MelissaDettwiller.com

                    www.physiqueboutique.com

                    Comment


                    • #11
                      Originally posted by melissa View Post
                      '
                      i feel ya'....i'm kinda partial to female butts myself, lol! but at least she will feel better about herself and THAT will be good for you as wel.....TRUST ME!
                      That must be why my wife wants it.

                      Comment


                      • #12
                        My wife had her surgery in late january. I kept my opinion to myself, I just told her "they are yours get what you are comfortable with". When we met with the doctor I told him the same thing. Basically don't ask me, you are not operating on me ask her.

                        After the surgery the doctor came out to tell me everything went well. He went on to ask me why I kept my opinion out of the discusions. I then told the doctor that if it was up to me her implants would make Pam Anderson look like a 10 year old girl. That is why I kept my opinion to myself.

                        Comment


                        • #13
                          Originally posted by melissa View Post
                          \

                          didn't you mean "WE'RE" getting a nice christmas present?
                          ha ha ha.. so true. most of the time, the implants are for the bf/husband. =)

                          Comment


                          • #14
                            i had mine done 1 yr ago. i was already a 34C and only wanted to go a little bigger. Anyway, after a while of thinking it through, I started getting more and more interested in going alot bigger. I am now a 36DD. I have to admit I like them but its very difficult to find perfect fitting, cute tops.

                            Comment


                            • #15
                              oh, boy! I have before and afters. Here ya go:

                              hardcoregymregistry.com * prettybuff.com * myspace.com/sallyagin

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