In an ideal world, we would be judged only on our personality, and not on our appearance. Unfortunately, we live in a culture which suggests that impossible standards and physical beauty are the norm. Most of us are too fat, too thin or too blemished to conform with the images churned out by the media. Many of us feel self-conscious and dissatisfied as a result.
Breast size is a prime example. Breast enlargement operations are becoming much more common and sales of push-up bras are booming. This is despite the fact that small breasts are as functional as large breasts for breastfeeding, do not go droopy with age, are a kilo less of flesh to carry around, are better for sports and look good.
The Independent newspaper has pointed out that women who have implants to please men may be wasting their time. “Men are far less discerning than women take them for,” Phil Hilton, editor of Men’s Health magazine, told the newspaper. “Men think all breasts are good and are delighted to have access to any at all. The idea that they are connoisseurs is inaccurate. There’s no need for operations and scars and that kind of thing.”
Boob booster pads
Boob boosters might be the answer. Department stores sell gel-filled breast enhancers that you tuck into your bra, which feel like real breasts. Or look for gel-filled bras.
Exercises, creams and pills
Exercises can increase the size of the muscle beneath the breast, but will not increase the actual breast tissue. There is no scientific evidence that electrical stimulation, non-hormonal creams or massage treatments have any effect.
Women with large breasts often find that they become much larger with hormone treatments, such as the oral contraceptive pill or hormone replacement therapy, or during pregnancy. This does not usually happen if the breasts were small to start with.
‘Natural’ pills to boost breast size are available in some health food stores. These often contain ‘phytoestrogens’, which are substances from plants that have an oestrogen-like effect on the body. The pills contain very large amounts (compared with the quantities of phytoestrogens we would eat as part of our normal diet). The effect of phytoestrogens on the breast needs a lot more study. Experts worry that they could encourage breast cancers, although some studies have suggested that phytoestrogens might protect against breast cancer. Whether or not these pills increase breast size is debatable.
Breast implant surgery
Breast implant surgery (breast augmentation) is the only method of making breasts larger. It is obviously essential that the surgeon is reputable. Talk to your doctor about it. In the UK, it is very unlikely that you can have the operation on the National Health Service – this is normally possible only if the breast is being reconstructed after breast cancer surgery, or if one breast is very underdeveloped compared with the other. If it is to be done privately, here are some things to think about.
Look at the very informative website from the UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA). This site explains the pros and cons very clearly, and has a list of points to discuss with your surgeon.
Check that the surgeon is a Fellow of the Royal College of Surgeons and a member of the British Association of Aesthetic Plastic Surgeons (see choosing a cosmetic surgeon and useful contacts); other countries have similar organizations.
Ask the surgeon to explain all the possible risks and, if you do not understand the explanation, ask for a clearer explanation.
Take a notebook with you, so you can write down important points.
After your discussion with the surgeon, go home and consider the information for a few days. In fact, the official recommendation is that there should be a ‘cooling-off’ period of several days between seeing the surgeon and having the operation, to give you sufficient time in which to change your mind.
Bear in mind that your implant will not last forever. The average silicone implant lasts about 16 years, so it might need to be replaced at some time in the future.
The operation. The implant is placed behind the breast tissue, between it and the chest wall muscle (although very occasionally, it is placed behind the chest wall muscle, between the muscle and the ribcage). It is never placed in the breast tissue, so it does not interfere with the function of the breast and you can breastfeed later on if you wish. The implants come in a great variety of sizes, so a correct-sized implant can be used to make your breasts look similar in size.
There will be a scar in the crease line under the breast. This will be red at first, but will gradually fade over 12 months. If a saline implant is used, some surgeons will be able to insert the bag of the implant by keyhole surgery (endoscopically) through an incision in the armpit. The bag is gradually filled with saline afterwards, and this technique means there is no scar on the actual breast.
For more detailed information about breast enlargement surgery, look at the British Association of Aesthetic and Plastic Surgeons’ website listed in the useful contacts.
Problems. A number of problems can occur after breast enlargement surgery.
After the operation, there will be some discomfort on moving your arms, but this wears off after 1–2 weeks.
Occasionally, blood collects around the implant in the first 24 hours after surgery, and the surgeon may have to reopen the incision to remove the blood.
Infections can occur and can usually be treated with antibiotics. However, if the infection is severe, the implant may need to be removed and replaced a couple of months later.
The nipple may feel sore or there may be loss of feeling in the nipple area. This is only temporary.
The scarred skin may become red and thick, and may stay like this for a year or two before starting to fade slowly. Tissue may tighten round the implant, squeezing it and making it feel much firmer. This used to be a common problem, but occurs less often with modern implants, which have a textured surface. If this happens, you may need another operation.
Types of implant
Silicone-gel implants produce the most natural-feeling breasts, and are still the most common in the UK, though they have had a bad press in recent years. In particular, some people thought leakage might cause ‘auto-immune’ diseases (arthritis-like diseases such as systemic lupus erythematosus or scleroderma). In fact, all the evidence shows this does not happen and that silicone-gel implants are safe.
Silicone-gel implants stopped being used in the USA in 1992 following the health scare. But now an independent panel of scientists convened at the request of Congress has concluded that silicone breast implants do not cause major disease, and has recommended that they should become available again (Lancet 2003;362:1384).
Researchers in the USA thoroughly re-examined data from 20 previous studies on silicone implants. The results, published in the New England Journal of Medicine in 2000, showed no connection between breast implants and connective tissue diseases.
Swedish researchers have studied 3486 women with breast implants for an average of 18 years, and found no increase in breast cancer risk (Journal of the National Cancer Institute 2006; 98: 557–60).
Leakage can, however, cause painful hardening of the breasts. In Europe, safety checks on implants were stepped up in 2003, and they now have a stronger casing to reduce the risk of leakage. If you have a silicone-gel implant, you should see your surgeon every year to try to detect leaks.
Silicone-gel implants show up as a shadow on X-rays. This means cancer cannot be detected easily by mammography in a person who has had an implant, and the breast has to be screened from special angles. If you have an implant, mention the it to the radiographer.
Saline implants may be safer than silicone gel implants and are the type used most frequently in the USA, but they may leak (which will mean another operation) and may also produce a rippled effect under the skin. They cause the same difficulties with mammography as the silicone type. They do not have the same consistency as breast tissue, so can feel wobbly and strange.
Soya-oil implants were used between 1995 and 1999. They are no longer used because some leaked into the breast, and it is feared that aldehyde chemicals from the oil could encourage cancers (though there is no evidence this has actually happened).
Tissue grown from our own bodies may be used as implants in the future. Researchers in the USA have taken fat cells from the thighs and buttocks, and grown them on breast-shaped polymer mesh. When the mesh is full it dissolves, leaving a piece of breast-shaped fatty tissue that could be implanted.
Written by: Dr Margaret Stearn Edited by: Dr Margaret Stearn Last updated:
Monday, January 16th 2012
GP and broadcaster Dr Phil Hammond shares his views on PIP breast implants and widens the debate on cosmetic surgery. What do you think? We welcome your comments below.
Useful contacts for Small breasts
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