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Breast augmentation is very popular

She put her name on a waiting list.

She saved $300 with the summer special.

She has a manufacturer’s warranty.

The product?

Bigger breasts.

They’re big business.

Medically, it’s referred to as augmentation mammoplasty. Most people just call it a “boob job.” Nationally, more than 254,000 women enlarged their breasts last year, making it the third most frequently performed procedure.

The 38-year-old woman we’ll call “Katrina” bought bigger breasts as a postdivorce gift to herself. “I wouldn’t have done it if I’d still been married,” she said. “But thinking of being single again, I needed some self-confidence.”

She refinanced her home and earmarked the equity to pay for the surgery. “So every month for 30 years, when I make house payments, I’m paying on my boobs, too.”

They cost her about $5,000, she said. The price range nationally is $5,000 to $7,000, with an average of $6,000. Most augmentations are elective cosmetic procedures and aren’t covered by insurance.

First, she got a surgeon recommendation from a couple of friends who had undergone the operation. Then she researched the procedure on the Internet, bought some books, read magazines and watched television shows.

She made the decision in March and had the surgery in July. “I was on a waiting list for a couple of months,” she said. “Then they had a summer special. The operation was $300 cheaper. I guess most people want to get it done before summer.”

The procedure involves making small incisions and inserting implants into a pocket created behind the breast tissue or chest muscle. Her incisions measure less than an inch, Katrina said.

Implants are plastic shells filled either with saline (salt water solution) or silicone gel. Most implants used today contain saline. Patients receiving controversial silicone implants must meet specific criteria and be part of an approved study.

Surgeons generally agree that silicone implants feel more like the real thing, but the FDA no longer approves of them except in specified circumstances.

In the early 1990s, health problems blamed on silicone implants resulted in a multimillion-dollar lawsuit against the manufacturer. The implants were banned for cosmetic use. Several follow-up studies failed to prove a definite connection between silicone implants and disease, but the FDA wants more information before it reapproves them.

Implants can leak or break through injury or normal activity. In the case of saline implants, the body simply absorbs the harmless solution. The implant, however, must be replaced.

Katrina’s implants feature a manufacturer’s warranty that includes a stipulation for an upgrade. “If one implant happens to leak saline,” she said, “I can go back and fix both of them and go up a size for no additional charge.”

Implants also may need to be replaced if there is bleeding or infection or, more commonly, if scar tissue forms around them. The scarring, called capsular contracture, causes the breasts to harden. A study by the FDA placed the contracture rate at 9 percent. Two studies on silicone implants showed that 13 to 21 percent of patients needed additional surgery after three years.

Fooling Mother Nature

Instead of settling for the whims of Mother Nature, implant patients get to choose an appropriate size. Katrina’s surgeon told her most patients pick a D cup. “I just went to a C,” she said. “I didn’t want to be huge, like, ‘Whoa! Look at that!’ And I do like to sleep on my belly.”

The surgery was performed in the doctor’s office under general anesthesia. She was given Valium that morning. Although the surgery generally takes a couple of hours, it seemed more like minutes, she said. “They draw on you, make all these marks, then they anesthetize you. It didn’t seem like any time before I woke up.”

They gave her pain pills, but she didn’t need them. She went back the next day to check for excessive bleeding and got her first look at the enlarged appendages. “I was pretty shocked when I first saw them because they were so big,” she said. “But they explained that was just swelling from the surgery.”

Later that day, she flew to Florida to recuperate with a friend. “I didn’t have any trouble carrying a suitcase or anything. It was just hard to sleep flat at night.”

Most patients can return to work in about a week if they don’t have to lift more than 15 pounds.

She wore a tight support bandage day and night for a couple of weeks. For a couple of months, she wore a D-cup bra to accommodate the swelling.

She loved buying new bras and clothing. “Everything I bought before was to camouflage how flat I was. Suddenly I looked obscene. My new breasts pulled on the buttons.”

Then, she braced for the reactions. “I met a boy a couple of weeks before the surgery. Afterward, he looked at me and said, ‘OK, I’m a guy, and we notice these things, and those weren’t there before.’

“But one of the greatest things about it is that most people didn’t notice I’d had surgery. They just thought I looked different, like I’d lost weight. I have big shoulders and big hips, so I was in proportion for the first time.

“I just wish I’d done it when I was younger.”

Breast reconstruction after a mastectomy uses the same principles but involves an additional step. “You’re not just making the breast larger; you’re creating shape,” said Charleston surgeon Andy Stewart. “And you also have to create skin. In the initial stage, we insert an empty implant that’s gradually inflated over many weeks to expand the skin. Then we take out the expander and put in a permanent implant.”

To contact staff writer Sandy Wells, use e-mail or call 348-5173.


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