According to the American Society of Plastic Surgeons, breast augmentation is the most frequently performed cosmetic surgery in the United States. In general, the procedure is very safe when performed by a Board-certified plastic surgeon using FDA-approved implants. Women choose to have the procedure for different reasons, and some contributing factors are age, post-childbearing changes in the breasts, significant weight loss and asymmetry.
Perhaps you’ve thought about getting breast implants but aren’t sure if it’s right for you, or you’re facing a mastectomy and considering reconstruction. We asked two prominent plastic surgeons in our area—David E. Berman, M.D., of Berman Cosmetic Surgery and Ariel N. Rad, M.D., Ph.D., of Sherber + Rad—for their input.
Who is not a good candidate for breast augmentation? Are there greater risks for some women than for others?
It is important to consider not just your physical reasons for wanting a change, but your emotional reasons as well. Women who have “unrealistic expectations or someone who has other goals, such as wanting to save a relationship or be more popular,” are not good candidates, said Dr. Berman.
“Patients who have had complications with prior augmentation are not ideal candidates,” said Dr. Rad. Also, “If a woman’s cosmetic goals place her health at risk, for example, a woman who wants an overly large implant for her frame may have problems with her incisions healing or back discomfort from the weight of the breasts.”
Women who have had radiation treatment for breast cancer, those who don’t have sufficient breast skin remaining or whose skin is very thin after a mastectomy also may not be good candidates for implants. Dr. Rad explains that women who have undergone radiation therapy, “have a 50 percent chance of developing capsular contracture, a scarring process that causes breast hardening and asymmetry around the implant.” In these cases, reconstructing the breasts using the patient’s own tissue rather than with implants may be the best option.
As far as the risk of complications, Dr. Berman said, “Clearly, people with significant health issues are at higher risk for complications, but overall, it is a very safe procedure.”
Dr. Rad said that women whose skin is thin and stretched, such as from large weight fluctuations, run a higher risk of implant migration and “double bubble” deformity. “This occurs when the weakened tissues of the lower breast can’t support the weight of the implants, stretching the lower breast skin and causing a bulge beneath the breasts. However, this can be corrected by reinforcing the area.”
What should a woman who is thinking about the procedure, but is unsure, consider?
Dr. Rad said one of the most important things to consider is whether your plastic surgeon is qualified (by education, training, Board certification and experience) to perform your surgery. “You should check that your surgeon’s certification is specifically from the American Board of Plastic Surgery. In addition, you should ask to see before and after photos and make sure that they represent the surgeon’s own work and are not representative photos from an implant manufacturer,” said Dr. Rad. “Experience is everything, and you must do your homework when vetting plastic surgeons’ qualifications.”
Besides checking on your surgeon, you need to perform a checklist on yourself and your motivations. Dr. Berman suggests asking yourself, “What are my goals? What do I want to achieve?”
Are there any new advancements that women should know about?
“There are now a multitude of sizes and shapes to choose from in both saline and silicone implants,” said Dr. Berman.
Both Drs. Berman and Rad also perform breast lifts, which can reshape and reposition breasts to a more youthful contour and may be considered as an alternative to or along with augmentation.
“There has been ongoing innovation in implant science to improve safety and performance. Now more than ever, there is a tailored solution for every individual goal,” said Dr. Rad. Some recent innovations include teardrop implants, which provide a more natural-looking breast shape, and the round Inspira cohesive gel silicone implant, which helps maintain upper breast fullness.
At what point should mastectomy patients consult with a plastic surgeon?
Not all plastic surgeons perform reconstructive surgery so be sure to do your research and get referrals from your breast surgeon. If you’re facing a mastectomy, you already have a lot to deal with, but you should spend some time learning about your options for reconstruction before your surgery. Not all mastectomy patients choose reconstruction. Some use breast forms or prostheses that are worn inside a bra or attached to the body, while others choose to do nothing at all, an option called “going flat.”
One important thing to know is that passage of the Women’s Health and Cancer Rights Act in 1998 ensures that breast cancer reconstruction is covered by insurance. Another is that making the decision about reconstruction before your cancer surgery may make it easier to get the results you want. “In the interest of coordinated care, I prefer to work with my breast surgery colleagues from the very beginning of care planning in order to optimize outcomes for my patients,” said Dr. Rad.