In 1998 over 130,000 women underwent breast augmentation. They joined the approximately 2.0 million women in the United States who have already had breast implants. This common cosmetic surgery operation is second only to liposuction. According to a statistical survey taken by the American Society for Plastic and Reconstructive Surgery (ASPRS) the number of women who had implants placed in 1998 showed a 306% increase over the number placed in 1992. This is despite extensive media coverage and concerns over silicone implants and the surrounding controversy in the last few years. The business of busts is booming.
Who are these women who are willing to undergo a surgical procedure to change their shape? The answer may surprise you. Certainly there are women such as exotic dancers, models, and actresses that do it for professional reasons. But, by far, the majority of women are normal everyday women in all walks of life, housewives, mothers, doctors, secretaries, businesswomen, neighbors, relatives, etc. The common misperception is that only younger women undergo this procedure. But the statistics show a wide spectrum of ages. 60% of women who undergo augmentation are between 19 and 34 years of age, but almost 40% of women seeking enlargement are over 35 years old. This second group is made up of thoughtful, mature women who have seriously thought about and researched their choice for years before making a decision. A common scenario is that these women do not want to be significantly larger they only want to regain what they have lost with childbearing and aging. They consider it restorative surgery.
Why are implants so wildly popular? The primary reason may be the great success surgeons have had with the procedure. It can be done as an outpatient surgery. The patient arrives early in the morning and may be home in her own bed by noon. Time off from work is relatively short. A patient with a sedentary job or who performs only light duties or lifting may be back to work in 5 days. Recovery time to full activities such as lifting or aerobics is usually 4-6 weeks. Probably the most important reason is that the risks are relatively uncommon. Of course there are risks and these need to be discussed with your surgeons and understood prior to undergoing any type of surgery. However only a relatively small proportion of women have any problems. Today women have a bewildering array of options. Perhaps too many. Choices include not just size but the type of implants, placement of incisions and location of implants whether above or below the pectoral muscle. The types of implants vary. Round implants are the most common and least expensive. Contoured implants are pear shaped and are felt to appear more naturally shaped. A contour implant is thinner up top and fuller at the bottom, more like a natural breast. This implant is more expensive and comes with its own set of advantages and disadvantages. There are implants that are adjustable and allow for fine tuning of the size post-operatively. These have small tubes and ports that must be removed with a second small operation. Only a tiny volume change is possible and is usually reserved for women with asymmetry that is difficult to correct in the operating room. The choice of implant surface is also an option with either smooth or textured surfaces. The implants can be placed through a small incision, usually just slightly longer than an inch, either in the fold at the base of the breast, around the nipple or in the armpit. A few surgeons are placing the implants through a small incision in the belly button with the aid of a surgical telescope.
No single implant or approach is best for all women. There are advantages as well as disadvantages to each implant and this should be discussed with your surgeon. The array of choices allows the women to actively participate in her care with her doctor and allowes them together to pick the best option to achieve the optimal result.
Today the implant most widely used is the saline or salt water filled implant. This is a very safe implant but the feel of the saline implant may be less natural than the silicone implant due to a differing viscosity of the filler materials. Due to controversy surrounding the silicone implant, this implant is not available to women undergoing first time enlargement. Silicone is still available to patients under certain specialized situations such as breast reconstruction following breast cancer.
The two main controversies surrounding implants are whether silicone implants cause disease and why women feel the need to undergo surgery in the first place. Societal pressure and the value that today’s society places on beauty and youth certainly plays a large part. The decision is a complex interaction of societal pressures, individual values, psychology, and self-image and is a very personal choice. What bothers one person may not concern the next person in the least. In fact, a 1998 study showed 34% of American women were dissatisfied with their breasts. Very few women who walk into a plastic surgeons office want to look like Pamela Anderson. For most, a sense of improved aesthetics including balance or proportion is the goal. They want to be able to buy and fit into clothes, or they want to feel less bottom heavy. For many it is liberating, for the first time in their life they can simply wear flattering clothing, a low cut dress or bikini, and not feel self conscious about their chest.
The silicone controversy continues since earlier this decade when there was some concern about the association of implants with medical problems. This was fueled by a Connie Chung TV expose. However, careful scientific studies continue to emerge showing the safety of silicone implants. On June 21 of this year the Institute of Medicine of the National Academy of Sciences released a 440-page report covering all aspects of silicone breast implants.
Some of the major findings were: 1. No increased risk of breast cancer or recurrence of breast cancer. 2· No association or elevated risk of developing connective tissue diseases. 3· No evidence of passing silicone to infants during breast feeding 4· Breast implants have improved since they were first introduced in 1962 5· In general, silicone is safe
The report also discusses side effects and complications such as localized problems in the area of the implant including hardening of the breast tissue surrounding the implant (known as a capsular contracture), implant rupture, infection, etc. The report is indispensable reading for any woman considering breast augmentation and is highly recommended. A concise 16 page version of the report is available online at http://books.nap.edu/catalog/9618.html on the Internet. Despite the medical evidence there is a community of women who continue to believe that silicone implants are associated with medical diseases. The last chapters have yet to be written on this issue.
Certainly the topic of breast implantation continues to be hotly debated. In the end, this is a very complex and personal decision and most believe that it should be left up to the individual woman. The above information is not meant to be a complete or thorough discourse on the subject, only an introductory primer. Medical knowledge and surgical techniques are constantly evolving. One of the most important factors, which cannot be underestimated, for a successful procedure is the development of a good relationship with your doctor. To be properly informed, a full and open discussion should be had with your physician.