Chest Right

Technically speaking, they are glands whose primary purpose is to produce milk. But while other glands, like your thyroid and your pancreas, go about their business with little attention, your mammary glands—otherwise known as your breasts—have come to represent so much more than a source of nutrition for newborns. Every week gossip columnists blast news of another celebrity who has gone under the knife to enhance her cleavage. Google "celebrity boob jobs" and you'll come up with thousands of sites cataloging the good, the bad and the ugly.

With all this attention, it's not surprising that breast augmentation has become the most common cosmetic procedure for women. Last year 347,524 women received implants, according to figures released last week by the American Society of Plastic Surgeons. That's a 64 percent increase since 2000—an amazing statistic when you consider that health insurance generally doesn't pay for implants that are purely cosmetic (which is not the case for breast reconstruction after cancersurgery).

Depending on where they live, women can shell out as much as $10,000 in total costs. Many may consider it money well spent because of the self-esteem boost they get from "fixing" small or saggy breasts. Younger women are primarily looking to enlarge breasts that they perceive as undersize, while older women want to restore the look of their breasts before they had children, says Dr. Laurie Casas, associate professor of surgery at Northwestern University Feinberg School of Medicine in Chicago.

It may be easy to forget, with all the tabloid talk about "boob jobs," that breast augmentation is real surgery, with potential complications. "It's like any decision you make," Casas says. "You listen to the pros and cons and you weigh them." A responsible surgeon should spend a good deal of time discussing those pros and cons with patients. Choosing an operation that is not medically necessary means extra due diligence. "This is elective surgery," says Dr. Richard D'Amico, president of the American Society of Plastic Surgeons and an assistant clinical professor of plastic surgery at the Mt. Sinai School of Medicine in New York. "We're not making you healthier. I feel there is a greater responsibility for safety because it is elective." Surgeons say that breast augmentation patients who clearly understand the risks and benefits are most likely to be satisfied with the results.

First, a little background: implants are silicone pouches filled with either silicone gel or saline and have been around since the early 1960s—before the U.S. Food and Drug Administration required safety tests for medical devices. In the early 1990s, responding to concerns from patients and some doctors, the FDA restricted the use of gel-filled implants. But in 2006, after considerable scientific review and debate, the agency once again allowed the marketing of gel-filled implants when it approved applications from two manufacturers.

Here's what you need to know (and ask) before surgery and what to expect afterward:

Selecting a Surgeon You want a doctor who is certified by the American Board of Plastic Surgery. That means he or she has graduated from an accredited medical school and has completed at least five more years of training as a resident in all kinds of surgery with at least two years dedicated to plastic surgery. In the initial consultation the surgeon should also spend considerable time explaining the risks and benefits and answering all your questions. Contrary to what many believe, breast implants are not permanent, nor are they maintenance-free. These two important facts should be mentioned during your conversation with the surgeon. Breast implants may last more than a decade, but at some point they will need to be replaced. You will also need to see the surgeon annually as long as you have implants to make sure that the implants have not leaked and that everything is still working as it should. If the doctor you pick doesn't inform you of this, you might reconsider your choice. "He's more interested in signing up the patient than preparing them for a lifetime of implants," says Dr. Foad Nahai, an Atlanta plastic surgeon who is president of the American Society for Aesthetic Plastic Surgery.