Too small, too large, too droopy, asymmetric…who doesn’t have one of these issues?Truthfully, asymmetry is the rule, not the exception.  Your breasts are not a matching set, just like one of your hands and one of your feet is larger than the other.  And look carefully, one of your ears sticks out more than the other and one corner of your mouth is higher than the other.Plastic surgeons never see patients who are satisfied by their appearance.  That’s why people come to see us.  And so they have devised procedures that are designed to make you…and your breasts…larger…or smaller…or more perky…or more symmetric.  Those procedures have become so safe and predictable that hundreds of thousands of women have them each year.

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The procedure that gets the most media attention is breast enlargement.  Also called breast augmentations—or even “boob jobs” (though I hate that term)—there were over 300,000 last year in the U.S. according to the American Society of Plastic Surgeons.  That’s a 50 percent increase over the last decade.  Part of that increase is because silicone gel implants are back on the market.  For over a decade, the only ones that were available were salt water (saline) filled implants.  While these implants fill the breasts, they feel like…well… water balloons.  And ones made of gel feel like…breasts.My goal as a plastic surgeon is to help my patients look normal and natural. Where breasts are concerned, I think they should simply be average size.

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One of my favorite cartoons shows a woman telling her plastic surgeon to make her breasts large enough so she can tell men to stop looking at them.  And that underscores the problem.  So many women feel that if they are going to have surgery, they’re going to get their money’s worth and make their breasts as large as possible.  But the truth is that all breast implants are mechanical objects that have progressively more problems as they get larger.  Breasts stretch out more with larger implants and look worse and worse over time.  It is the plastic surgeon’s job to explain the risks and benefits of implants to patients.I’m not sure when a request for giant implants becomes malpractice if it is granted, but I do know that I won’t perform the surgery if I feel a woman is becoming excessively large.  Call me old fashioned, but I won’t cut off a thumb either if someone wants a more symmetrical hand.  I have to feel good about the surgery I’m doing.The best breast augmentations are those that are not detectable—in or out of clothing.  Too large implants bulge up high, near the collarbone.  While this looks unnatural, I’ve actually had requests from women who want that look.  Most people don’t get the opportunity to see a lot of naked women except in pornographic magazines, and most of the women in those magazines have had breast implants.  So after decades of overdone breast augmentations, people have started to think that the overdone look is actually normal…and they want that look.  I have to tell women that I can’t knowingly create what I consider to be a complication

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Implants come in all different shapes and sizes and are made of silicone gel or filled with saline.  They can be smooth or textured, round or oval, they can be placed over or under the pectoralis muscle, and can be placed through incisions under the breast, around the areola, in the armpit, and for gymnastic surgeons through the belly button (I don’t recommend that incision).There are lots of risks with breast implants, but most are minor.  My biggest concern is that they block breast tissue making mammograms less useful.  To stay safe with implants, you should have MRIs of the breasts in addition to mammograms.  These see right through the implants but cost a lot of money and won’t be covered by insurance.  Since breast cancer is so common, if you can’t afford MRIs, then please don’t put implants in your breasts.The largest chapter in my book, Straight Talk about Cosmetic Surgery, is about breast augmentations. Check it out before you alter your breasts.

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