Chest Right

What Your Surgeon Should Ask You The surgeon you choose should give you a thorough medical evaluation to make sure you have no underlying health problems, such as diabetes or hypertension, that could get in the way of a successful outcome. Patients with these problems may still be able to get implants; doctors just need to know the full picture. As part of the evaluation you also need to disclose your complete medical history so that the surgeon is fully informed. Safety, says D'Amico, is "a joint responsibility between the patient and the plastic surgeon." The evaluation may turn up reasons to postpone or avoid surgery—and it's important for you to pay attention to that. "If a reputable board-certified plastic surgeon says you shouldn't do it, please don't find somebody else," says D'Amico. A good surgeon will also ask you about your reasons for wanting implants. He or she is looking for warning signs that a patient has unrealistic hopes about what the procedure can accomplish. A doctor might, for example, discourage a woman who wants bigger breasts just to please a boyfriend or to save her marriage. "This is not about solving social problems," says D'Amico. "It is about addressing breast size. While they may be related, we want to make sure that patients have appropriate expectations." Elective surgery should always be a carefully considered choice—not an emotional one. "Women must think of this as a very, very serious decision, because you are electively choosing to put a foreign body in your body, and you have to do it for the right reasons," says Casas, who also has a private practice in Glenview, Ill.

Finding a Facility You've probably heard stories about procedures gone wrong. Often these are performed in unregulated facilities. So check out the venue. If you are having surgery somewhere other than a hospital, ask if the facility is either licensed by the state or accredited by one of these three organizations: the American Association for Accreditation of Ambulatory Surgery Facilities, the Joint Commission, or the Accreditation Association for Ambulatory Health Care. D'Amico says that facilities that meet these criteria have an "outstanding" safety record—comparable to a hospital's.

Silicone vs. Saline You and your doctor will decide which works best for you. Saline costs less, and if it leaks the body absorbs it. You'll also know right away that something is wrong, because the leaky breast will go flat, says Nahai. Silicone implants feel more natural, but leaks are harder to detect because the gel may not migrate. If it does move into another part of your body, like your arms or your upper abdomen, you will feel a lump that has to be removed, says Nahai. Women who choose saline because they don't want silicone in their body should understand that the saline-filled pouch is still made of silicone, so there's no such thing as a silicone-free implant. According to the American Society of Plastic Surgeons, 121,551 women picked silicone implants last year, while 225,971 chose saline.

Why Age Matters Under the current rules, women who are at least 22 can get silicone gel-filled implants. The age minimum for saline implants is 18. (The age restriction doesn't apply to women who are getting implants for breast reconstruction.) When their celebrity idols appear to be sporting bigger boobs, many younger women want to follow suit. But the restrictions are in place for a reason. Breast tissue is still growing through late adolescence, and young women may not understand the full medical implications of implants. "I personally do not think it is appropriate for a 16-year-old to have breast implants as a sweet 16 present, and the FDA doesn't approve either," says Nahai. On the other end of the age spectrum, Nahai says he has even operated on a woman in her early 70s, with good results. However, older women (even in their 40s) may need a breast lift in addition to implants to fix saggy breasts, doctors say.

Picking the Placement Implants can be placed either behind the chest muscle or within the breast tissue. The choice generally depends on the size and shape of your breasts and the type and size of implant, but there can be other issues as well. While implants in any part of the breast hide some breast tissue in a mammogram, implants behind the muscle may be a better choice for women with a family history of breast cancer who rely on mammography screening, says Nahai, because more breast tissue will be visible. Behind-the-muscle placement may be more painful, and the recovery takes a little longer. Surgeons often advise women at high risk of breast cancer to see an oncologist before deciding whether to get implants.

After the Operation Even if you've chosen a top-flight surgeon in a superb facility, you can have problems. About a quarter of patients have some kind of complication within the first two years after their first surgery. The most common, called capsular contracture, occurs when your body forms an eggshell of scar around the implant, D'Amico says. It affects about 15 to 20 percent of patients and isn't a major problem for many—but some women will get an uncomfortably hard scar and may need surgery to correct it. Some women experience temporary (or even, in a few cases, permanent) numbness or extra sensitivity of the nipple. Very thin women who get saline implants may also find that the outline of the implant is palpable or even visible through the skin. "We refer to that as rippling," says Nahai.