Take one look at any Hollywood awards show -- and all the plunging necklines -- and you've seen enough to know that big breasts are back in.
Breasts are indeed getting bigger. After 34B reigned as the most common bra size for nearly a decade, last year 36C emerged as the best-selling bra size in America, according to the market research firm NPD in Port Washington, N.Y. And an increasing number of women are getting fuller breasts via the operating room. Implant surgery is more popular than ever: 191,583 women nationwide had breast-augmentation surgery in 1999, up 51 percent from the previous year, according to the American Society for Aesthetic Plastic Surgery. Just a decade ago, implants were under heavy fire. Studies suggested a possible connection between silicone-filled implants and connective-tissue diseases and autoimmune disorders, such as rheumatoid arthritis and lupus. The Food and Drug Administration (FDA), citing inadequate evidence that silicone-filled implants were safe, banned them from the market in 1992, with a few exceptions, such as use in clinical trials. However, a 1999 report by the Institute of Medicine found no connection be tween silicone implants and autoimmune or connective-tissue diseases, nor did another study published in The New England Journal of Medicine. Still, the debate over implants continues. A more recent study published in The Journal of Rheumatology suggests there is a link between silicone breast implants that leak and fibromyalgia, a painful musculoskeletal rheumatism. And while researchers from the National Cancer Institute recently found no connection between silicone implants and most cancers (including breast cancer), they did find small increases in risks for lung and brain cancers.
Today, for most American women seeking breast enlargement, the only option is saline-filled implants. Following the silicone controversy, the FDA looked at saline implants (which have a silicone shell), but so far, research hasn't established a connection between saline implants and increased rates of disease. And despite the risk of side effects (see "What to Know About Implants," page 118), record numbers of women are getting implants.
Here, two women who made the decision to get saline breast implants -- one woman who loved the results, and one who didn't -- share their stories with Shape.
"I love my new breasts."
Ashlie Solow, 27
Production assistant, Los Angeles
I was heavy as a little girl, but by age 11, I became truly overweight. My breasts started developing, and when a few girls in sixth grade began wearing training bras, I was already wearing a woman's bra. I was so embarrassed by my breasts, I slouched and wore big T-shirts. And my breasts just kept growing.
Of course, I was very self-conscious about my weight too. During a PE class, we had a weigh-in, and I was heavier than all the other girls. I tried to lose weight in junior high and high school, but just didn't have the motivation to stick with a diet and wasn't active. I preferred to sit and watch TV. Besides, my breasts were so huge, they got in the way of my doing anything athletic.
By the time I was 21, my bra size was 38DDD, so I decided to have a surgical reduction. I weighed around 210 pounds (I'm 5 feet 4 inches), so the surgeon I consulted recommended that I lose weight first to make the surgery safer. But I was so sensitive about my weight that I didn't even want to acknowledge I had a problem. Finally the doctor went ahead and did it. I guess he knew how miserable I was and thought the surgery would really help me.
Luckily, I had a relatively easy recovery. I was sore and uncomfortable for about two weeks, but I was also excited. I was still a 38 chest size, but my cup size was now a D.
When I saw how much smaller I looked with smaller breasts, it gave me a kick-start to change the rest of my body. I signed up for an aerobics class -- my first real exercise -- because I finally fit into a sports bra. It felt great to be active, and I signed up for more classes. When I cut out the fatty foods I used to eat, the weight just started coming off, I was still overweight, but I felt really good about myself. I finally felt healthy.
Eventually, my weight leveled off at 150 pounds. I felt better about my body but wasn't happy with how my breasts looked anymore. When I lost weight, they just emptied out. Without a bra, they completely sagged. I trusted my surgeon, so my decision to get implants was an easy one. We talked a lot about the risks. I was concerned about possibly losing nipple sensitivity and the ability to breastfeed, but in the end I trusted that he knew what he was doing, and I really wanted "normal" breasts. So in 1998,1 had the augmentation. My breasts were a full D cup again and looked like breasts, not shells. I could even go without a bra. I took off the bandages and went out with my friends, wearing a tight, low-cut shirt. I felt proud of my body, and I wanted to show it off.
Getting the implants gave me another push to lose weight. I wanted the rest of my body to be as beautiful as my breasts. Now, going to the gym is part of my regular routine. I love aerobics, running and lifting weights, and I watch what I eat. Today, I weigh 125 pounds, and I feel like a different person. I'm happy with myself. Now, guys pay more attention to me. The breasts and the weight loss don't hurt, but I also have a lot more confidence. I'm not just more secure about my looks: I feel athletic now, like I can do anything. My bra size is 32D. And though I recently had to have surgery again to adjust my right implant, which had moved and caused a dog-eared look in my skin, I'm even happier, because now my breasts are really perfect.
Would I do it all over again? Definitely. The confidence boost my implants gave me was worth it.
"I got implants and hated them."
Patricia Fernandez, 32
Assistant manager, yoga studio, Los Angeles
When I was younger, I was very ashamed of my body. I was really skinny and flat-chested, and I always wanted breasts. So when I was 21,1 decided to get implants.
At the time, I was a very flat A, and I wanted to go to a B. But my doctor convinced me to get a C, because he said so many of his patients ended up wishing they'd gone bigger.
I liked my new breasts at first. I just kept thinking, "I finally have boobs!" I felt like I could finally stand up straight, instead of slouching to hide my flat chest.
Then about six months after the surgery, my breasts started getting hard. Called capsular contracture, it's one of the side effects that can happen: The scar tissue that forms around the implant contracts, making your breasts hard. My doctor told me not to worry and to massage my breasts. But I had to massage the tissue every day for 15-30 minutes for my breasts to stay soft. If I skipped a day or two, they'd get hard again.
After a couple of years, my breasts had become so hard they were like cantaloupes. They were painful too. And no matter how much I massaged them, they weren't getting softer. So my doctor cracked the scar tissue. He literally squeezed each breast between the heels of his hands. Doctors don't do this anymore because it's dangerous -- the implant could rupture -- but that's what my doctor did back in 1993. It was unbelievably painful. I could hear the scar tissue cracking and tearing. He told me to wrap my breasts in bandages at night to keep them soft. But my breasts got hard again pretty quickly. I started keeping them wrapped all the time -- to try to hide them.
By this time, I was starting to realize how stupid these things were. I was so thin that I looked ridiculous with huge breasts -- I felt like a stripper. I was so self-conscious that I never wore tank tops. I couldn't sleep on my stomach, and sex was becoming difficult. I didn't want my boyfriend touching my breasts, because they didn't feel good; I had hardly any sensation in them anyway. I would lie down and they'd stick straight up.
After I'd had the implants for about five years, the hardening around them got so bad that I asked my doctor if he could just take them out. He said I'd had them so long that if he did, my breasts would be like flat tires. I was horrified, of course. So instead, he scraped out the scar tissue and replaced the implants with smaller ones. I went from a C to a B cup.
Within months, my breasts got hard again, So even though they were smaller, they still looked fake. I hated them. I finally went to a new doctor and had the implants removed. He left the scar tissue, so my breasts wouldn't look deflated. After a couple of months, the tissue softened because my body wasn't fighting the foreign implants anymore, and now my breasts look great. They're a full A.
It's ironic -- I got implants because I was so ashamed of my body, but after I got them I was still just as ashamed. It wasn't until I had them removed that I finally felt comfortable and sexy. Now I love my breasts, and I love my body.
Jeannie Kim is a free-lance writer in New York City.
what to know about implants
disease risks Research hasn't found a link between implants and most cancers or autoimmune diseases, like lupus. But a recent ongoing study by the National Cancer Institute has linked implants to higher rates of lung and brain cancer (but it's unclear whether smoking played a role in increased lung cancers, since there was no control for this). Also, implants can make mammograms harder to read, increasing the risk of an undetected cancer.
potential side effects Breast implants may, have side effects, including capsular contracture, where excess scar tissue forms possibly causing pain and making breasts hard and unnatural-looking. In this case, the surgeon must remove scar tissue surgically, then reinsert the implant, says: Laurie A. Casas, M.D., FACS, assistant professor of surgery at Northwestern University Medical School in Chicago. But as Patricia Fernandez's story (on the opposite page) shows, even this doesn't always remedy the problem for good.
Another potential side effect is loss of nipple sensation, which can occur if nerves are damaged during surgery. "If the implant is inserted directly under the skin, as opposed to under the pectoral muscle, there's a greater chance of damaging the nerves responsible for nipple sensation," says John Altobelli, M.D., a plastic surgeon in private practice in Allentown, Pa. Sensation loss may or may not temporary.
Also, nerve damage during surgery could cause an inability to breastfeed. Unfortunately, no long-term, prospective studies have been done on this, so there are no definitive data. For more on side effects, read the Food and Drug Administration's report at fda.gov/cdrh/breastimplants.
how to choose a surgeon consult your surgeon several times before committing to the procedure. "He shouldn't schedule surgery on your first visit; he needs time to get to know you and answer all your questions," Altobelli says. For a list of board-certified surgeons, visit the American Society of Plastic Surgeons' Website, plasticsufgery.org.
the real cost The national average cost of breast augmentation is close to $3,000. But implants typically need to be replaced (over time they can weaken, leak and deflate) so there can be additional costs later.
thinking about breast reduction?
If you've suffered from back, neck and shoulder ailments brought on because of your very large breasts, you may have considered breast-reduction surgery. Unlike implants, breast-reduction surgery, which costs around $5,000, is more often covered by medical insurance. However, there are several possible complications, such as large scars, which usually go around the areola and down the center and along the underside of the breast; the possibility of bleeding and infection; and complications with breastfeeding, since the nipple and areola may have to be completely removed during surgery, severing nerves leading to them.
Since surgery poses greater risks of complications to overweight patients, women who are overweight and contemplating breast-reduction surgery should seriously consider committing to a healthy weight-loss program first.
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