On Monday I testified in front of the FDA General and Plastic and Surgery Devices Advisory Committee on breast implant safety. I think I surprised a lot of people in the room when I stated that I wasn’t crazy about breast implants. Let me clarify a bit.
For the flat chest woman who could be mistaken for a boy with gynecomastia or a pubescent girl, and who does not have enough available fat for fat transfer, breast implants can be beneficial. Ditto for women who have a significant breast asymmetry or tuberous breast deformity that cannot be significantly improved without implants. And some women with a pear shape (big hips and thighs and a narrow chest and small breasts), implants can add balance and be very beneficial. Also, for women who have experienced deflation after pregnancy and nursing or after major weight loss, breast implants can restore volume to an extent that fat transfer usually cannot. For mastectomy patients who are not good candidates for autologous reconstruction, implant based reconstruction can restore a sense of wholeness. For these patients, breast implants are very beneficial. And really, some patients find implants to be life changing in a good way. Don’t judge a woman’s desire for implants until you’ve gone bra shopping with her breasts. That’s the upside of breast implants and really, all aesthetic breast surgery.
Now I would like to wander into territory that a male plastic surgeon could not go lest the sisterhood ask for his head. I would like to discuss the concept of bimbofication. There are many, many women with perfectly fine breasts (defined by me as a nice shape and a size proportionate with the rest of their body) who opt to go larger, sometimes much larger in order to produce a hyper-sexual look and persona. And I think this is a bad idea. Bimbos have a very short shelf life and getting what one wants via this sort of manipulation of certain types of men is not a good game plan at any age and is not going to work after a certain age. It just won’t.
I also think that breast implants have skewed the vision of the ideal. It is not normal for lean women to have huge breasts. Yes, it occasionally occurs in nature (and a lot of them come in for breast reduction!) but it is not the norm. I do think that the tide is turning some. I think a more natural look is becoming more fashionable and I, for one, am glad to see it. And for those who think I make millions stuffing breast implants into unsuspecting victims: if implants disappeared tomorrow my bottom line would likely go up because of my interest and expertise and experience in non-implant based aesthetic breast surgery.
Are breast implants safe? I think smooth shell implants are. (Textured implants, on the other hand, are worrisome.) Breast implants have been around since the 1960’s and have undergone many design changes and a lot of scrutiny. Many of the studies looking at implant safety are sorely lacking in follow-up (that’s also another blog) and it should come as no surprise that inserting a large foreign body has a lot of implant related down sides – rupture, deflation, malposition, capsular contracture, etc. And they are not life time devices and have to be removed and/or replaced eventually. I recently did a permanent removal of a ladies fifth set! Do I think breast implants cause systemic illness? I think there may be a teeny, tiny subset of women who are sensitive to the materials in implants. But I think breast implants are safe for the vast majority of women who choose to have them.
Now would I let my mother have implants? No, she passed away 2 years ago (at 97!). She had a full and lovely set probably because she did not breast feed her three children (it wasn’t in fashion in the 1950’s). How about my sister? I don’t have one but one of my sisters-in-law had postmastectomy reconstruction with an expander followed by an implant and balancing breast reduction and she looks better than she did before breast cancer. She is thrilled with her result. And how about my daughter? She is heading off to college this fall and will be making many, many decisions about her life without my input. Actually, she has been making most of her decisions for a while now. This is just one of many decisions. Fortunately this young lady has a healthy body image and zero bimbo tendencies. Lucky me.
So there you have it. Implants are beneficial for many, many women and for some they are not. I’m just glad to live and work in a society that allows adults to make their own choices! You should be too.
Thanks for reading and I would be honored if you followed me on Instagram @breastimplantsanity and @sowdermd. Dr. Lisa Lynn Sowder