Breast Augmentation: A Public Health Perspective
By: Diana Zuckerman, PhD
Introduction
More than 150,000 women had breast augmentation surgery last year; an all-time high. At the same time, the number of teenagers who choose breast implants has more than doubled in the last two years.
And yet, the controversy about breast implants still rages. As is often the case when the media covers medical issues, there are experts on all sides of this issue, and the consumer is left totally confused.
As a Congressional investigator in the early 1990s, I had access to all published and unpublished studies of breast implants, and was appalled to learn that almost one million women had breast implants, but they had never been objectively evaluated in either clinical trials or epidemiological research. That situation has changed. After the FDA started restricting access to silicone gel breast implants, the implant manufacturers started to fund research in an effort to prove that they were safe.
As a scientist trained in psychology and epidemiology, I have studied both the desire for implants and the possible physical risks. Despite all the controversy and media coverage about breast implants, there are surprisingly few studies on the psychological benefits of implants, the local complications caused by breast implants, or the long-term risks. Instead, there is a great deal of misinformation in the media, and many women make the decision to get breast implants with unrealistic expectations about how it will change their lives, little awareness of the financial consequences, and without the resources to cope if problems do occur.
Breast Implants and Self-Image
Plastic surgeons claim that breast implants have a very positive impact on a patient’s self-image. It would be easy to study this objectively, by evaluating women’s self-esteem and body image before, after, and several years after getting breast implants. No such study has ever been conducted.
Surveys indicate that when plastic surgeons ask their patients if they are satisfied, most say that they are. However, that is not an objective way to study the impact on breast implants. There is no doubt that some women are very satisfied with their breast implants, but any evaluation of patient satisfaction should be conducted by someone other than the plastic surgeons or their staff. If you want honest and accurate answers, it is important for patients to feel that their answers are anonymous. Since implants are a lifetime commitment, it is also important to study them several years later, since that is when problems become more likely.
From a psychological point of view, improving one’s appearance, with plastic surgery or other means, can help a person feel better about himself or herself. On the other hand, there are individuals who feel unattractive because of a particular physical shortcoming, who then “solve” that problem, and then focus on a different shortcoming. There are other potential problems specific to implants: a woman who changes her appearance by getting breast implants may find that men treat her so differently that she feels uncomfortable. If the implants seem obvious (for example, because of the swooshing sound of saline, hardness from capsular contracture, or because they don’t feel the same as natural breasts) she may become more self-conscious rather than self-confident.
Are Breast Implants Approved by the FDA?
It may surprise you to learn that there are almost no published studies of the safety of saline breast implants, and that no breast implants were ever approved by the FDA until a few months ago. In May 2000, for the first time, the FDA approved several styles of saline breast implants made by two manufacturers, Mentor and McGhan. The FDA decided to give women the choice of buying implants even though FDA advisors expressed a great deal of concern about the complications experienced by many women with implants. The FDA did not approve saline implants made by other manufacturers, and did not approve some of the styles of implants previously sold by either Mentor or McGhan. That means that many women are walking around today with implants that never were approved by the FDA and probably never will be.
Saline breast implants are made with
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