In a culture that emphasizes the way women look, many women feel dissatisfied with the faces or bodies nature gave them and choose to improve their appearance through plastic surgery. Cosmetic breast surgery — whether it is breast augmentation with implants or breast reduction — has implications for health as well as beauty.

Do breast implants cause disease?

No scientific studies have shown that implants increase the risk for breast cancer. Furthermore, research has shown again and again that silicone breast implants do not increase the risk for any kind of systemic disease, including autoimmune diseases or connective tissue diseases.

Juries have in several instances awarded large settlements to women who claimed that they had autoimmune problems after their breast implants leaked. In this highly charged atmosphere, the Food and Drug Administration in 1992 banned the use of silicone in new implants until safety could be assured. The agency did not, however, demand that silicone implants already in place be removed unless they were leaking significantly. Later the agency amended the decision, allowing the use of silicone gel implants for reconstructive breast surgery after mastectomy.

What kind of breast implants are available today?

Today the implants available are either filled with a saline solution or made from a woman’s own tissues. Natural tissues can be removed from other parts of the body — the abdomen or the back. Along with the tissues, skin, fat, and muscle are taken to provide circulation for the living tissues. Silicone gel implants are currently being studied and are available from doctors participating in these clinical trials.

What kinds of problems can breast implants cause?

The usual problems are leakage from the implant and scarring from the surgery, but in terms of causing medical diseases, transplants are safe.

If silicone gel breast implants are not causing problems, is there any reason to have them removed?

I urge women with silicone gel breast implants to continue their monthly self-exams, mammograms, and yearly breast exams, but I see no reason to remove implants that are not causing problems.

When is breast reduction worth considering?

Breast reduction is plastic surgery that decreases the size of one or both breasts. It is appropriate for women whose breasts are so large that their size interferes with upper-body function. Some women with very large breasts have problems with posture and back, neck, and shoulder pain. Other problems are skin rashes in the folds beneath the breasts and breathing problems. Large breasts can interfere with athletic activity, and they can cause social pain, particularly for young women and teenagers.

Will insurance pay for breast reduction surgery?

If you are having the surgery to relieve neck, back, or shoulder pain, then your insurance should pay for it. If you want breast reduction surgery for psychological or social reasons, you certainly have the right to have the procedure, but your insurance will probably not cover it.

Can a woman breast-feed after she has had breast reduction surgery?

It depends on how the plastic surgeon has done the reduction. Often, it is possible to nurse, but if you are considering this kind of procedure, you should discuss it very carefully with your surgeon ahead of time.

Can I have breast reduction or augmentation surgery if my breasts are different sizes?

It is not uncommon for women to have asymmetrical breasts. The difference in size between the two breasts is not generally dramatic, although in some women it can be significant. The difference, especially noticeable during early puberty, may even out with age and hormonal changes.

Adolescent girls in particular find the asymmetry extremely distressing, because at this age they are very concerned about the appearance of their bodies. Often I can reassure a young woman that asymmetrical breasts are merely a variation on normal, and that with a little “tincture of time,” her body will develop according to its own pattern. Only in rare cases is surgical intervention necessary.

Since asymmetry can be a sign of cancer, it is important that the change in size is not something new. If your breasts have always been asymmetrical, there is no problem; but if they have recently become so, you should consult your physician right away.

What are the risks of breast reduction surgery?

Breast reduction is considered major surgery. It is done in a hospital, usually with a general anesthetic. The procedure may take as long as three or four hours. Any surgery carries with it the risks of infection, adverse reaction to the anesthesia, and bleeding — though these risks are slight.

The surgery will always leave scars on the breasts, which will be quite visible (though they are likely to fade somewhat with time). Some women have a risk of large, raised scars (keloid scars) from this or any other surgery. Before you have surgery, ask your surgeon to see examples of the results of the different procedures, so that your own expectations will be reasonable.

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