The title really doesn’t have to say more than that to get your attention. As a plastic surgeon, I rarely meet a woman who is satisfied with both their size and shape. Too small, too large, too droopy, asymmetric…who doesn’t have one of these issues? And truthfully, asymmetry is the rule, not the exception. Your breasts are not a matching set, just like you have one hand and one foot larger than the other. And look carefully, one of your ears sticks out more than the other and one corner of your mouth is higher than the other.
Plastic surgeons never see patients who are satisfied by their appearance. That’s why people come to see them. And so they have devised procedures that are designed to make you…and your breasts…larger…or smaller…or more perky…or more symmetric. Those procedures have become so safe and predictable that hundreds of thousands of women have them each year.
Certainly the procedure that gets the most media attention is breast enlargment. Also called breast augmentations or even “boob jobs” (though I hate that term), there were over 300,000 last year in the U.S. according to the American Society of Plastic Surgeons. That’s a 50% increase over the last decade. Part of that increase is because silicone gel implants are back on the market. For over a decade, the only ones that were available were salt water (saline) filled implants. While these implants fill the breasts, they feel like…well… water balloons. And ones made of gel feel like…breasts.
My goal as a plastic surgeon is to help my patients look normal and natural. And where breasts are concerned, I think they should simply be average size. One of my favorite cartoons shows a woman telling her plastic surgeon to make her breasts large enough so she can tell men to stop looking at them. And that underscores the problem. So many women feel that if they are going to have surgery, they’re going to get their money’s worth and make their breasts as large as possible. But the truth is that all breast implants are mechanical objects that have progressively more problems as they get larger. Breasts stretch out more with larger implants and look worse and worse over time. It is the plastic surgeon’s job to explain the risks and benefits of implants to patients. I’m not sure when a request for giant implants becomes malpractice if it is granted, but I do know that I won’t perform the surgery if I feel a woman is becoming excessively large. Call me old fashioned, but I won’t cut off a thumb either if someone wants a more symmetrical hand. I have to feel good about the surgery I’m doing.
The best breast augmentations are those that are not detectable – in or out of clothing. Too large implants bulge up high, near the collarbone. While this looks unnatural, I’ve actually had requests from women who want that look. Most people don’t get the opportunity to see a lot of naked women except in pornographic magazines, and most of the women in those magazines have had breast implants. So after decades of overdone breast augmentations, people have started to think that the overdone look is actually normal…and they want that look. I have to tell women that I can’t knowingly create what I consider to be a complication…
Implants come in all different shapes and sizes and are made of silicone gel or filled with saline. They can be smooth or textured, round or oval, they can be placed over or under the pectoralis muscle, and can be placed through incisions under the breast, around the areola, in the armpit, and for gymnastic surgeons through the belly button (I don’t recommend that incision).
There are lots of risks with breast implants, but most are minor. My biggest concern is that they block breast tissue making mammograms less useful. To stay safe with implants, you should have MRIs of the breasts in addition to mammograms. These see right through the implants but cost a lot of money and won’t be covered by insurance. But since breast cancer is so common, if you can’t afford MRIs, then please don’t put implants in your breasts.
The largest chapter in my book, Straight Talk about Cosmetic Surgery, is about breast augmentations. Check it out before you alter your breasts.

You don’t need a plastic surgeon to tell you that cosmetic surgery is incredibly popular. You just need to pick up one of those magazines at the grocery store checkout counter. Cover stories about who had great plastic surgery sit next to ones about cosmetic surgery disasters. And those tabloid covers pretty well sum up the state of cosmetic surgery – incredibly popular and wonderful but potentially dangerous.
Recently, you might have read stories about airplane grade silicone used in French PIP brand breast implants. That’s an example of corporate irresponsbility that has resulted in women getting sick. And you read about nutty mothers assaulting their prepubescent children by pushing botox and other procedures on them. And you read about the woman who strove to have the largest breast implants on the planet earth….until they got infected, were removed, and she attempted suicide. And so it’s no wonder that some people have said, “enough is enough” and called for the ban of cosmetic surgery.
Well, hold on a minute. Ban cosmetic surgery? What about all the good that cosmetic surgery does? Like it or not, self esteem is linked to body image. And so teenagers who have the shape of their noses surgically improved can evolve from introverts to extroverts. And women who have breast augmentations can better fill out clothing. And those who have enormous breasts know that breast reductions decrease symptoms of back and neck pain, and improve exercise tolerance. And tummy tucks can improve posture and decrease back pain. And eyelid lifts can actually improve vision and decrease symptoms of dry eye syndrome. And the list goes on.
A while back, I published a study that documented an improvement in happiness and a decrease in depressive symptoms following all sorts of cosmetic surgery. That study has been corrorborated by many others. These reports should not be taken lightly. Our society spends billions on improving quality of life, on things as diverse as entertainment, spas, and yes, cosmetic surgery.
The truth about cosmetic surgery is that every person has different needs and can tolerate different levels of risk. And it is up to a sensible, non-greedy plastic surgeon to explain the types of procedures that are available, from skin care to noninvasive procedures, to real surgery. The risks of each procedure need to be honestly assessed and explained. And finally, surgeons needs to be able to turn down patients who are either not realistic or have medical or psychological risks that exceed the benefits of the chosen procedures.
Cosmetic surgery provides wonderful benefits, improving appearance and psychological wellbeing. And recipients of cosmetic surgery span all aspects of society – from blue-collar workers to clerical workers, to chemists, to celebrities and even politicians. Successful cosmetic surgery relies on the responsibility of surgeons and companies that provide the drugs, implants, and devices that fuel the specialty. And, finally, cosmetic surgery requires that both the surgeon and the patient exercise some common sense.
For more information about cosmetic surgery, check out my book, “Straight Talk about Cosmetic Surgery”, available everywhere.