10 Breast Implants, Reduction and Repair

• Breast reconstruction has a very high patient satisfaction rate but has a higher complication rate than most other cosmetic surgeries. This is because with implants, a "foreign" substance is left in the body.
• Most current breast implants in the U.S. are salt-water-filled silicone bags. The silicone making up the bag is inert.
• The silicone-filled "gel" implants currently are used only for reconstructive or secondary procedures. However, there is no medical evidence that they cause any harm, and they may be available soon for all breast surgeries.
• Size, shape, and where to put the incision and the implant are extremely important. The patient and the doctor make these decisions as a team.

Just as styles of clothes, architecture and music change from decade to decade, so do styles of bodies. In the 1950s, Marilyn Monroe and Jayne Mansfield epitomized America's ideal of the perfect woman's body, with round curves and ample bosoms (dress size 12 to 14!). But if either of these actresses tried to get a role in Hollywood today, they'd have to hire a personal trainer and lose 25 pounds first.

The poster girls of the 1970s and early 1980s — like Farrah Fawcett, Cheryl Tiegs, and Heather Locklear — popularized slim bodies with small breasts. Then, when the 1980s brought us aerobics, women strived to achieve tight, muscular bodies. Since the 1990s, large breasts have once again become part of the picture.

Many women seek breast reconstruction because their breasts are asymmetrical, or one is less developed than the other. A woman who's had a breast removed because of cancer may also desire breast reconstruction. Some women whose breasts sag after having children, or women who are unhappy about the way gravity has pulled their breasts down with age, simply may wish to rejuvenate them.

Occasionally men have breast surgery, because they have excess breast tissue or "gynecomastia." This can occur for a variety of reasons: steroid use, tumors, alcohol or drug abuse, or sometimes excess testosterone has been converted by the body to estrogen during adolescence. Most men who are examined and tested have no clear cause for their condition, but have usually been unhappy about it for many years. When treated successfully, these men are among the most grateful of all cosmetic surgery patients.

Women seek breast implant surgery for a variety of reasons. There are those who feel their breasts are too small. Additionally, there are the women who have had children and want to restore breasts that have been deflated by pregnancy and breast feeding. Most of these would be happy with full "C" cup or small "D" cup postoperatively. Other women want very large breasts for professional reasons. Still others need implants changed due to some complication from a prior implant surgery. Lastly, there are women who want their breasts reduced in size or lifted. Many of these women in the latter group are candidates for liposuction alone (discussed further on in this chapter), while others will need complex surgery that leaves scars around the nipple, down the front, and under the breast — the "anchor" scar. Some need both an implant and skin reduction, which also requires these incisions and results in scarring.