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The
decision to undergo cosmetic breast surgery - breast
augmentation (implants), breast lifts, or breast reduction
- should be made after careful consideration of all
the risks and benefits. Men suffering from Gynecomastia,
enlarged breast tissue, are also turning to breast surgery.
Donna,
a 22-year-old sales consultant, had breast augmentation
surgery for the best of reasons: herself. "I didn't
want to look like a beauty queen," she says. "I
wanted to look normal."
While
Donna's right breast was a B cup, her left breast never
developed. The casual observer would never have known,
as she was a master at camouflaging her flattened chest
with special bras. But after awhile, she wanted to have
similar-sized breasts, like other women. Her insurance
company deemed the operation medically unnecessary,
so with the cost coming from her own pocket, she wanted
to find a surgeon who would do the job well. Donna turned
to Dr.
Mark Granick, then practicing in the Philadelphia
area. "I felt very comfortable with him. He put
me at ease," she says. "Every question and
concern I had, he addressed."
The
same-day surgery went well for Donna, but she admits
that the recovery period was rougher than she anticipated.
It would have been much worse, she says, without friends
and family to care for her, an ample supply of videos,
and lots of ice.
Today,
Donna is pleased with the results. She is now an even-sided
36 C cup and happy that "I didn't do it for anyone
else but myself."
Julie
also had breast augmentation surgery. When she was an
A cup, she always wished she were fuller breasted, like
her sisters. How her wish came true was partly happenstance.
The 39-year-old personal trainer worked at a rehabilitation
facility/fitness center and met Dr. Granick there when
he made an educational presentation on facelifts. She
mentioned that she was interested in learning more about
breast implants and shortly after, she had a consultation
appointment to talk about what the surgery entailed.
"I
told Dr. Granick I wanted to have cleavage, but not
look garish," says Julie. "Other than that,
I trusted him to select the type of implant and suggest
a size that would go well with my body build and height.
He has a great, easy going manner."
Julie,
too, experienced discomfort following her June 2000
surgery, but she was back to work in one week. And today,
she says she would do it all over again. "I've
told hundreds of people about how great implants are
and have even suggested breast lifts for my sisters,"
says the personal trainer.
As
these women's stories show, the most defining feature
of the female body-her breasts-are for some women the
most disappointing or embarrassing. From the AAA cup
to the overly endowed, many women try to change their
appearance by using different styles of bras or taking
supplements that claim to alter breast size.
These
temporary, often ineffective, and possibly unsafe efforts
do little to induce lasting change. Plastic surgery,
when performed by an experienced, board-certified surgeon,
can provide a woman with the breasts she wants in a
safe, supportive, and supervised setting.
And
it's not all about vanity. Women with extremely large
breasts often have back and neck pain. From a practical
standpoint, it's difficult for adult women at both ends
of the breast-size spectrum to buy clothes that fit.
Even men with unusually large breasts can suffer emotionally.
Where
to Start
Before
a woman steps into a plastic surgeon's office, she should
have realistic expectations about what surgery can do
for her. It cannot mend a broken relationship or pave
the way to Hollywood stardom. The patient should consider
all aspects of the surgery, not just the final result.
"It's
a decision that requires maturity and thought,"
says Dr. Granick, who recently became professor of surgery
at the New Jersey Medical School and chief of plastic
surgery at University Hospital. "She should understand
the consequences of the surgery, know what she is doing,
and why. For example, like all mechanical devices, implants
wear out over time. A woman who undergoes breast augmentation
in her early 20s needs to realize that by the time she
is in her 40s, she will need another set of implants."
There
are many choices when it comes to plastic surgery of
the breast, but none are as important as the selection
of the plastic surgeon. The most significant criterion
is the surgeon's certification. While there are many
self-designated boards, only the American Board of Plastic
Surgery is accredited by the American Board of Medical
Specialties for plastic surgery of the breast. It's
also desirable for the surgeon to be a member of the
American Society of Plastic Surgeons, which has standards
for physician behavior and ethics, as well as continuing
medical education.
Patients
need to do their homework and ask a lot of questions.
"There are many subspecialties in plastic surgery,
so the patient needs to find a surgeon who is experienced
in the specific procedure she or he is interested in,"
says Dr. Granick. "Ask friends and acquaintances
who have had cosmetic work what they liked and didn't
like about their surgeon. Primary care physicians and
nurses often know who has a good reputation, both in
terms of surgical skill and dealing with patients."
"Another
big question to ask is, 'Can I easily talk to this surgeon?,'"
adds Dr.
Parham Ganchi, assistant professor of plastic surgery
at the New Jersey Medical School, and a board-certified
plastic surgeon. "Communication is key. If the
surgeon is not courteous or tries to pressure you into
additional procedures, the best thing to do is get up
and walk away."
Breast
Implants: Safe or Risky?
Perhaps
no other plastic surgery procedure has come under more
scrutiny than breast augmentation--specifically, with
regard to the safety of breast implants. About 40 years
ago, when silicone prostheses for mastectomy patients
were developed, manufacturers also used the material
for cosmetic breast implants. Problems emerged when
some silicone implants hardened, but the biggest blow
came during the 1990s: Concerns were raised that women
with silicone implants had higher rates of breast cancer
and that they caused systemic illnesses such as rheumatoid
arthritis. A moratorium was placed by the Food and Drug
Administration on silicone implants, except for research.
"Large
studies have shown that there is no link between silicone
implants and systemic illness or breast cancer,"
says Dr. Granick. "In fact, there's evidence that
women with silicone breast implants had lower rates
of breast cancer."
Still,
routine screening mammography is recommended for women
with implants. The technician needs to know if a woman
has implants so that different techniques can be used
to take X-rays of the breast.
Saline
implants have been used for breast augmentation since
the 1970s, but in their original design, tended to leak
or deflate. Today's variety are greatly improved. Leakage
problems are rare, says Dr. Granick, and most manufacturers
offer a five-year warranty on saline implants and keep
detailed records about them.
Once
the safety issue was resolved, the number of breast
augmentation surgeries skyrocketed. In 1992, 32,600
procedures were performed. In 1999, the number had risen
to 167,000-a 413 percent increase.
Reshaping
the Breast
Breast
augmentation, breast reduction, and breast lift (mastopexy),
while elective procedures, are not taken lightly by
the surgical team. Not all women who want them are considered
good candidates.
”Some
women may not be good candidates for the surgery, poor
emotional stability, or a strong family history of breast
cancer might cause us to think twice,” says Dr.
Ganchi. “Women planning to breastfeed should consider
postponing breast reduction surgery, which involves
moving the areolae and nipples, or breast lifts--as
breastfeeding can stretch the breast downward--until
after weaning.” And pregnancy-whether or not a
woman plans to breastfeed-affects the breasts' shape,
he adds.
Breast
augmentation
If
there's one significant advantage to saline implants
over silicone, it's a small, 1-inch incision. "An
incision is generally made either underneath the breast
or through the armpit," says Dr. Granick. "The
implant is inserted deflated, and then once in place,
the saline is added." Most surgeons prefer to place
the implant below the breast muscle, rather than breast
tissue, for a more natural look.
The
surgery, done as a same-day procedure under general
anesthesia, is usually routine. However, as with any
surgical procedure, there are risks to the operation.
Afterward, there may be a loss of nipple sensation or
the development of capsular contracture, which is caused
by scarring around the implant. Many patients find they
are tired and sore for a few days after the surgery,
as muscle and tissue heal and the breasts adjust to
the implant. Most women resume work and regular activities
within a week. About a month after the surgery, the
implants have rounded out and the breasts look more
natural.
Breast
Lift
Some
women are happy with the size of the breasts, but not
the sagging brought on by aging, significant weight
loss, or breastfeeding. A breast lift involves removing
extra skin on the lower part of the breast and repositioning
the nipples and the areolae; implants can be also be
inserted. There are different techniques that can be
used, but all are usually done with the patient under
general anesthesia. After surgery, the breasts may be
slightly sore for a couple of weeks, but most women
resume their regular activities-excluding rigorous exercise-within
a week.
Breast
Reduction
Large,
heavy breasts can cause back and neck pain, as well
as embarrassment. Bra straps can dig into a woman's
shoulders, and she often finds it difficult to find
well-fitting clothes. In 1998, about 70,000 women had
breast reduction surgery. Sometimes insurance companies
will cover this procedure if it is considered medically
necessary.
A
surgeon can reduce the size of breasts by removing excess
fat and tissue and then repositioning the areolae and
nipples. This is a same-day surgery, during which the
patient is given general anesthesia, and it may take
about two weeks until the patient can resume work and
other activities.
“New
techniques can make this surgery virtually scar-free,”
says Dr. Ganchi. “Minimal scar breast reduction
is possible now, and many women are opting for this.
However, it depends on the individual.”
It's
not only women who can be overly developed.
Gynecomastia,
a benign enlargement of the male breast tissue, is estimated
to affect between 40 to 60 percent of men. Usually there
is no medical reason for men to have large breasts,
although some drugs can allow breasts to overdevelop.
In 1999, 9,000 men had surgery to reduce the size of
the breasts. A combination of liposuction and directly
removing breast tissue is commonly done during this
same-day procedure.
The
Cost of Beauty
While
some insurance companies will cover medically necessary
breast reduction surgery, most consider plastic surgery
of the breast to be an elective procedure. That leaves
the patient to determine how to pay for the surgeon's
fee and the hospital bill. The overall cost of breast
augmentation is between $5,000-$7,000 and is usually
payable in advance.
Donna
received a loan from her credit union to pay for her
surgery, and there are companies that specialize in
lending to plastic surgery patients. The ASPS has a
financing affiliate that charges interest based on the
risk of the surgery. A low-risk operation would carry
a lower interest rate than a high-risk procedure.
For
Dr. Ganchi, the reward of performing plastic surgery
of the breast comes from his patients' satisfaction.
“It’s a great feeling to know you’ve
helped someone feel better about themselves.”
Dr. Granick agrees. "Their breasts look more beautiful,
their clothes fit better, and their self esteem often
improves," he says.
Just
ask Donna. "As I was being prepped for surgery
and they were drawing lines on my breasts, I began to
cry," she says. "I said, 'It's the last time
I will have to be embarrassed by looking at my breasts."
For
more information about breast augmentation or reduction,
please visit the University Cosmetic Surgery Center
Web site at: www.TheUniversityHospital.com/plastics/
or call (973) 972-8092.
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