Breast Enhancement Surgery Makes A Comeback

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Public opinion and recent scientific studies have once again swung the pendulum in favor of breast implants in the United States. After the FDA restricted the use of silicone implants in 1992, plastic surgeons experienced a precipitous drop in the number of breast augmentations they performed. The government’s concern at the time were reports that silicone implants were causing generalized symptoms in some women (Rheumatoid arthritis, lupus and other auto immune diseases). In the years that followed multiple large studies were performed at leading medical centers yielding consistently favorable data. In 1997, the Institute of Medicine independently reviewed this data for the US Congress and found conclusively that there was no evidence that silicone implants were responsible for any major diseases of the body and that these devices did not increase the risk of primary or recurrent breast cancer. Since then, many other studies have solidified these conclusions reassuring the public that silicone and saline implants are indeed safe.

With this increased confidence in implant technology, more women chose to have breast enhancement in the year 2004 than ever before. In fact, the American Society of Plastic Surgeons reported that 254,140 American women underwent the procedure in 2003 compared to 32,607 in 1992. This number continues to rise steadily and our town is no exception. Breast Augmentation has become one of the most commonly performed cosmetic procedures in the US, and in our local practice it is by far the most popular surgery. We now perform over 400 breast augmentations yearly, an 800% increase from our 1994 numbers when we opened the first plastic surgery clinic at the lake. This number is not surprising considering 34% of American women in a 1998 study were found to be dissatisfied with the shape and size of their breasts.

Improving breast contours and unevenness may seem trivial and vain at the surface, but the emotional implications are far reaching. The boost in self-confidence that we witness in our patients makes this procedure extremely rewarding. A significant number feel a lack of femininity and have an altered body image similar to our mastectomy patients before their reconstruction. Those that are severely underdeveloped (Figure 1) avoid bathing suits and instead wear bulky t-shirts to obscure their flat chests. Their gratitude after the surgery is unparalleled and they invariably become an important source of referrals to our growing practice. These days, once women have decided to undergo augmentation they are faced with a plethora of options: silicone vs. saline, round shape vs. contoured, smooth surface vs. textured, pre-filled vs. inflatable, under the chest muscle vs. over, in the hospital vs. the office, sedation vs. general anesthesia; not to mention the different size implants and manufacturers available, as well as which incision to use and whether or not other procedures are required (breast lift and constriction release among others). It can become overwhelming?

After personally performing over 2,900 breast augmentations and carefully reviewing our data as well as other studies, I have developed certain bias over the years that I would like to share with you.

First, the issue of silicone vs. saline implants. Although the Institute of Medicine unequivocally ruled out the association between silicone gel implants and systemic diseases, local problems with the breasts such as silicone leaking and hardening, while not life-threatening, were concerning to this committee. My personal preference is to use saline implants. These can and do eventually deflate (<1% yearly) but the salt water used to fill them is completely harmless to the body.