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As a Congressional investigator in the early 1990s, I had access to all published and unpublished studies of breast implants, and was appalled to learn that almost one million women had breast implants, but they had never been objectively evaluated in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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Some women are getting implants as a graduation gift from their parents! This means that they are still teenagers!!! First of all, can this be safe for these young girls!!! Secondly, isn't there something morally wrong here?! Yes, if these girls are 18 they can make their own decision. However, shouldn't the parents be the ones guiding their children? Shouldn't the parents be informing these children about the risks?!!!

i agree.......a few days ago i was watching a show on vhi and it said that about 90 % of teenage girls get plastic surgery before they turn 20!..........thats insane!!!!! girls do not finish developing until they are about 21 22 and here these 18 year old girls are getting implants!!! i think their parents need to be realistic and stop letting their daughters do whatever they want....they need to wake up and be a parent and not a pushover!

This issue was also brought up on the radio the other day. This problem might be bigger than we think! There are many girls getting implants at the age of 18!!!

Hi,

My problem was slightly different, and larger. When I was 10, I was flat as a board, by 12, I was a C, by 16 I was a D, and by college I was a DD. By 27, I was a DDD. I was a dancer from 2-18, cheerleaders and had a very fit body....but I was cursed with these large objects on my chest. My Great Great Aunt is the only other person in my family who had these large breasts. I was teased my entire life and as I grew up, I noticed back and neck pains starting to develop. When I was 18, I looked into a reduction. The only problem was, insurance would only pay if I went to a B. I couldn't go from a DD to a B, I would feel flat. So I held off...the pain got worse and it was to the point that the best feeling was taking my bra off at the end of the day. I was uncomfortable in my own skin. I had to have bras and bathing suits specially made for me. I had to wear over sized shirts and anything that didn't show off my upper body. I would have to buy mismatched EVERYTHING. XXL tops and M bottoms. It was awful!
The back pains were so bad, that I figure I better do something before I have a child and I end up with F's or G's (OH HEAVENS). So this past March I had a breast reduction. I was so scared....what if I didn't look like me, what if they were different sizes, what if I couldn't breast feed, what if...what if...what if!!!! I found one of the top plastic surgeons in California and he was incredible. I must have spent 3 hours during my consultation asking questions, hearing answers and putting my mind at ease. I also did my due diligence and researched my doctor on all the medical boards. Needless to say it was without a doubt the best thing that ever happen to me. I now feel comfortable in my own skin...and I can wear small tops and small bottoms!!!
I just wish these girls who want enlargements can walk a day in my shoes. Boobs are only fat sitting on your chest. They do more harm them good!!!!!