“Breast changes” was the reason listed on the chart of a recent patient I saw in my office. She arrived in near hysterics, noting that since she had stopped nursing her breasts had become “flat, lumpy and droopy”. She was adamant that something was wrong and her fear was that it was the worst: cancer. After examining her, luckily I was able to reassure her that her breasts changes were normal. She literally sighed in relief that she didn’t have breast cancer. But next she looked at me quite innocently and asked, “So when do they go back to normal?” I cringed, took a deep breath, and gave her the bad news, “sorry, they don’t.”
Pregnancy, childbirth, weight changes, gravity, and genetics all take their toll on breast tissue over time. Many women simply invest in quality bras to hoist their ladies back into place, but others look to breast implants to give themselves a permanent boost. At 300,000 procedures a year, breast augmentation is the most common type of cosmetic surgery in the United States. If you are thinking of joining the club, there is a lot to consider about before you go under the knife.
It’s important to consider the right timing. Plastic surgeons recommend that women should be healthy, not smoke, have fully developed breasts and be at a stable weight before considering implants. As an OB/GYN, I would also encourage you to consider waiting until you are done having children as well. Pregnancy and nursing can cause significant changes and the implants could be the wrong proportion afterwards. Also, after experiencing the breast swelling of pregnancy and engorgement of nursing, some women realize that larger bosoms are perhaps less fun than they thought they were.
It’s important to do it for the right reasons. In my experience the women who seem most satisfied with their decision to get implants are the ones who do it for themselves. Like the patient example I gave, they simply want to feel back to normal. They are not trying to look like swimsuit models, they just want to feel proportional and have their clothes fit properly.
I have had patients who got implants to please their partner or to try to salvage a relationship, but they almost always regret it.
It’s important to have realistic expectations. They will be larger and fuller, but they aren’t exactly natural-looking. With implants you will have a 3 to 4 inch scar under each breast and if you also have a breast lift there is often an anchor shaped scar extending down from the nipple as well. Implants do not feel or move quite the same as natural breast tissue and can shift over time.
And they are yours for life, so at 80 you will have the breasts of a 20 year old, which may sound like a good thing but can look a little odd. I recently saw an elderly woman for her annual checkup, as I began to perform her breast exam she whispered quite discreetly, “Just so you’re aware, I have implants.” I tried to mask my smile, as it doesn’t really take 12 years of medical school to notice the scars and the fact that they didn’t budge at all as she laid on her back.
It’s important to know the risks. Breast augmentation is usually a low risk outpatient procedure, but it is surgery and with any surgery there is always a risk of bleeding or infection. Other complications can include loss of nipple sensation, hardening of the implant (contracture) and wrinkling of the implant. While, implants do not cause breast cancer, they can make it more difficult for the mammogram to detect cancer. Breast augmentation where the implant is inserted in the crease below the breast and placed under the muscle, should have minimal to no effect on breast feeding, but implants placed through the areola can cause breastfeeding issues. Whereas, woman who have breast lifts and reductions usually cannot breast feed.
I will embarrassingly admit that when I was younger I was often judgmental toward women who decided to get implants. I thought it was a superficial, “un-feminist” thing to do. What I realized over time is that life and gravity can take their toll on the body and implants are one of the few ways that science can cheat that a little. I’ve seen it make a difference in the lives of patients and friends who feel so much more confident in their own bodies after getting implants.
If you are unhappy with your breasts, and are okay with the risks of the procedure then you might consider implants. Just make sure you have really thought about why you are changing yourself.
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