Cosmetic breast surgery: is it for you?

Breast reduction surgery

Women with large, sagging breasts are prone to neck and back pain and soreness where the bra straps cut into the shoulders. They also may develop rashes or sores at the junction where their breasts and the chest wall connect--a problem aggravated by perspiration and hot weather. A chest that is out of proportion to the rest of the body makes exercising more difficult and some women feel that they are taken less seriously in their professional lives.

Breast reduction surgery (reduction mammoplasty) can solve these problems. In a procedure that dates back three centuries, fat, tissue, and skin are removed from the breasts. This leaves them smaller, lighter, firmer, and more in proportion with the rest of the body. While usually done on women in their early 20s who have stopped growing, more and more women in their 60s are also choosing the procedure. Aside from the benefits mentioned above, breast reduction can relieve the stress on an aging skeleton.

While generally considered safe, the procedure is not recommended for women who intend to breast-feed at some point. Breast reduction surgery leaves extensive and permanent scars in locations normally covered by a bra or bathing suit; the scarring becomes less obvious over a period of 6-12 months. Even with careful preoperative marking and measuring, as gravity and time move the tissue within the breast after the surgery, the breasts may become slightly mismatched.

The procedure takes approximately three hours. It is usually performed on an in-patient basis under general anesthesia. The hospital stay is usually one to two days. If you are a smoker, you will be required to kick the habit for at least the week prior to and the week following surgery. Most surgeons will insist that you lose excess weight prior to surgery.

There may be some discomfort and bruising following the procedure, and only non-strenuous activities are allowed during the three weeks after surgery. You'll probably be required to wear a bra 24 hours a day during this period. Some loss of feeling may occur in nipples and breast skin for a period of weeks. In some patients it may last longer, and in rare cases it may be permanent.

According to Scott L. Spear, M.D., F.A.C.S., professor and chief of plastic surgery at the Georgetown University Medical Center, the key risks associated with breast reductions surgery include "Bad results in terms of appearance, scarring, and losing the nipple or some breast skin due to circulation problems during surgery." However, the result is usually excellent and normally results in immediate changes to a woman's self image and physical comfort.

Because heavy, pendulous breasts can cause back and neck pain, skin irritation, skeletal deformities, and breathing problems, reduction surgery is more likely to be deemed medically necessary than augmentation surgery. Therefore, it is more frequently covered by health insurers. Some insurance companies may require that a certain amount of tissue be removed to qualify for coverage. Check with your health care insurer to predetermine whether your surgery will be covered.

Breast augmentation surgery

Having bigger breasts doesn't guarantee happiness. Nor does it solve emotional or psychological problems. But some women do find breast augmentation to enhance their feelings of attractiveness, and by extension, self-esteem. Despite controversy and negative publicity in 1992 over the potential health hazards of silicone-gel implants, there has been a recent upswing in the number of saline implant surgeries. According to the American Society of Plastic and Reconstructive Surgeons, the number of women electing to have saline implants in 1997 climbed to 122,000, from an all-time low in 1992 of 32,607.

Because such surgery is usually considered "cosmetic," you'll probably have to pay for the procedure yourself; the usual costs run between $5,000 and $6,000. The surgery will be performed on an out-patient basis, either under a local anesthetic and sedation or general anesthesia, and takes one to two hours. Patients are usually discharged after a two-hour period spent in a recovery area following surgery. As you may be drowsy, someone should be available to escort you home following your discharge. Again, smoking is prohibited during the week prior to surgery.

According to Dr. Spear, breast augmentation surgery is more painful during the 48 hour post-operative period than reduction surgery, although the recovery period of three to four weeks is comparable. As with reduction surgery, scarring does occur.

Surgeons are now using saline-filled implants almost exclusively in breast augmentation surgery. These implants are composed of a silicone shell filled with salt water. Because saline is similar in composition to our other body fluids, the saline solution will be absorbed by the body if the implant breaks. The risks associated with the use of saline-filled implants include:

• Deflation Breast implants don't last forever. Some implants deflate or rupture within the first few months following surgery; others often last for years. Injury or normal wear and tear take their toll. Surgery is required to remove and replace the implant when deflation occurs.
• Difficulties in detecting breast cancer. The implant can make detection of breast cancer difficult by hiding breast tissue. Implants can also make mammography difficult to perform, and it's possible for an implant to rupture during mammography. Make certain to inform your mammography technician of the presence of an implant prior to undergoing a mammogram.
• Capsular contracture. Scar tissue that naturally forms around an implant can tighten and squeeze the implant, which can result in changes in shape, hardness, or pain. In severe cases, additional surgery may be necessary to correct or remove the implants.

There is a significant likelihood that a woman with breast implants will have to undergo additional surgery or surgeries to repair or replace the implants. Other risks include shifting of the implants, bruising, and changes in feeling of the nipple and breast. There are also questions, yet unanswered, about whether or not saline implants can cause autoimmune diseases, increase the risk of cancer, or endanger nursing infants.

Dr. Spear says that women with implants should schedule follow-up exams every year or two for the rest of their lives.

Finding the right surgeon

Once the decision has been made to undergo cosmetic breast surgery, the next step is finding the right surgeon. Spear recommends that women take the following steps to find the surgeon that is right for them:

• Ask your physician, hospital referral service and friends for recommendations.
• Contact the American Society of Plastic and Reconstructive Surgeons for a list of board certified surgeons in your area.
• Seek out books and magazine articles listing the "best doctors".

Breast surgery is not something to undertake lightly. But more and more women have decided that the prospects of many years of looking and feeling better and an enhanced self esteem are worth the temporary pain, the inconvenience, and in some cases, the cost.

Is it right for you? If your expectations are realistic and you look for improvement rather than a miracle, breast surgery can make a difference.