Dear Alice,

I always had small breasts until I became overweight. I am now going on a medically supervised diet. I know that I am ready to really lose the weight and keep it off. The only trouble is that I am only a size "B" cup now. When I lose the weight, I am sure to be an "A," or even an "AA." So, I have been considering the possibility of breast implants. Can you tell me some of the repercussions of breast implants? Can you breast-feed later? What happens during pregnancy? What are the health risks? Well, any information you have about the topic would be helpful. Thanks!

— Flatty but not a Fatty!

Dear Flatty but not a Fatty!,

It's a good idea to ask questions and do a bit of research as you consider the possibility of getting this surgery. There are a number of possible health risks involved with breast enhancement surgery. You also asked what, if any, effect the procedure might have on your ability to breast feed and what might occur during pregnancy. The short answer to those questions is that it’s difficult to say for certain (more on that later). And, though your line of questioning specifically asks about health risks, it’s also a good idea to make sure you have clarity about your reasons for wanting to increase your breast size before proceeding.

In terms of the procedure itself, a consultation with a surgeon would typically entail a discussion about your general health, medical history, lifestyle, hopes, and expectations for the procedure’s outcome (check out the U.S. Food and Drug Administration’s (FDA) helpful list of questions you might want to ask during  an appointment). S/he would also explain various options such as outpatient versus overnight stay, sedation versus general anesthesia, type of implant, location of implant, and type of incision.

There are two different kinds of implants approved by the FDA: saline and silicone. Implant type and size is generally based on skin elasticity, desired size increase, breast anatomy, and body type.Saline implants are filled with sterile salt water.Silicone implants are filled with gel that feels much like actual breast tissue. Manufacturers occasionally introduce new types of implants, so there may be additional options available.

Health risks of the surgery and of the implants can include (but are not limited to):

  • Reactions to anesthesia
  • Infection
  • Pain, bleeding, swelling, and bruising
  • Implant leakage or rupture
  • Undesired cosmetic changes, such as wrinkling, dimpling, and puckering
  • Improper healing around the implant or incision site
  • Visibility of implant or ability to feel it through the skin
  • Changes in nipple and breast sensation (temporary or permanent)
  • Capsular contracture, or firm scars that form around the implant
  • The need for additional procedures/surgeries — breast implants are not considered lifetime devices

About the impact on pregnancy, baby, and the ability to breastfeed: there are some unknowns in this area. There have been a few studies that found no higher rates of birth defects in babies born to mothers with breast implants. As far as breastfeeding is concerned, some mothers with implants have the ability, while others do not. Additionally, because there’s no established way to detect silicone in breast milk, it isn’t known whether silicone can pass through the implant shell and into breast milk (and be passed to the baby).

A surgeon will have a better sense of which concerns will be most relevant for you. Talking with others who have had the surgery can also be immensely helpful, not only in helping to identify a quality surgeon, but also in providing a sense of what to expect. Considerations about the cost of getting breast implants and the possibility that implants may need to be replaced after a certain number of years may also factor into your decision. 

Knowledge of health risks can certainly inform whether or not to go ahead with the procedure, but what about factors beyond weight loss that might be influencing your decision? What are the benefits, as you see them, of having larger breasts? Are there any potential non-health related drawbacks for you? What would be your ideal size? And what was your process in deciding that this size would be better for you? Women are bombarded by messages about how women's breasts should look. Family, friends, lovers, advertising, movies, and many other influences shape people's views on this. It may be a useful exercise to think back about your own influences as you work through your decision.

For more information about the procedure, associated health risks, and additional recommendations to consider, check out the FDA website.

Breast of luck to you!

Alice!

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