Over the past couple of years, I have noticed a change in the landscape of breast surgery that appears to be ongoing and real, at least in my part of the country. In the past, selection of large breast implants was the norm and, though “go big or go home” still happens, it is less common. Over the past few years, I have been seeing the following trends:
1. Women are selecting smaller implants for augmentation.
2. Women who have larger implants are wanting them removed or replaced with smaller ones.
3. Women having lifts are, in many cases, going without implants or choosing small ones.
4. Many women are having implants removed.
Why this change? That is a good question. I think there are a number of factors at play here and all are legitimate. The first consideration is the awareness of problems with the newer implants. I must make a point here; The gel and saline implants used today have been shown, over time, to be very safe and any significant issues are rare. However, as with any implant or treatment, 100% safety is never attainable and risk vs. reward is what we as Cosmetic Surgeons help you with when considering any procedure. Awareness of concerns with breast implant associated ALCL have certainly been an issue. This lymphoma has been almost exclusively tied to one type of implant that was recalled, but any concern can lower confidence. Another issue is the increased awareness of breast implant associated illness. Though poorly understood and rare, social media discussion groups have elevated concern about implants for many. Last, and I think the most important, is a change in lifestyle and social norms that make larger breasts a liability for some. Women are more active now than ever. Women participate in activities and events where large breasts can hinder performance, making large breast implants a liability. Social norms have certainly changed in favor of smaller breasts in the workplace as well as athleisure wear and other popular fashions that promote a more athletic build with smaller breast size.
All that being said, the trend I see is moving towards what I would call “small and perky” breasts, for lack of better terminology. Women with adequate breast tissue can achieve this with a breast lift alone in many cases. Women with large implants can have them removed with a lift and, in many cases, have a great result. Those with inadequate breast tissue during a lift, or when removing implants, have the option of remote fat grafting for augmentation, if only small amounts are needed. Fat grafting comes with some caveats however. Those choosing this option must be willing to accept some uncertainty with long term volume and the possibility of multiple procedures to get the results they are after. There are also possible long-term changes in the breast that can cause confusion at mammogram time. Of course, the other option is to choose a smaller implant with a lift giving a more predictable result. One option I offer as a fall back, is a staged procedure where we do the lift with implant removal and capsulectomy first if needed, then allow a 4-6-month healing time and re-evaluate. An implant or fat grafting can be done at that time. This option removes doubt about what the breast will look like and gives a better idea of what will give the best result. At Swetnam Cosmetic Surgery we do our best to make you happy and give you the result you desire. If you are contemplating breast surgery, we can help. Call us today or go to our website www.swetnamcosmetic.com.