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Breast implants boost self-esteem for many women, but some feel let down.

How Will Breast Implants Change Your Life?

Breast Implant Replacement & Other Realities continued...

About 1% to 2% of breast implants break or deflate each year, and the majority will likely need to be replaced eventually, says Casas. "Patients have to deal with that reality ... Nothing lasts forever."

So you must expect at least one second breast implant surgery in your lifetime, and perhaps several.

Another factor to consider: A woman’s breasts naturally change over time, while the breast implant stays the same. Breast implants that looked good at age 22 may no longer look good on the same woman after she has had children, breastfed, or grown older.

Postpartum women -- finished with pregnancies -- won't have so many breast changes, especially if they have kept their weight under control, says Casas.

She's seen a handful of 18-year-olds and talks them into waiting awhile -- to see if this is what they really want. "This is a major decision, and maturity level makes a difference. They're the ones who have to take care of the implants, continue with follow-up."

"We impress on them that this is a long-term project ... a lifelong journey," Casas says. "There's no reason to rush it. We will only move forward if they can make that commitment."

Deciding About Breast Implants: An Emotional Journey

Most women who get breast implants are realistic about the surgery, says David K. Wellisch, PhD, professor of psychiatry at the David Geffen School of Medicine at UCLA. He has authored a textbook chapter on the subject.

For them, it's a body image issue, he says. "They simply are not happy with their bodies and wish to improve them. They have realistic expectations that if this is done, they will look more satisfying to their own eye and to others. But their self-esteem does not depend on it."

However, the journey to the operating table can be emotionally painful for some. One study showed that in the year before their breast implant surgery, women reported greater distress about their appearance and more teasing about it. They also spent more time in a psychiatrist's office than women who didn't get the surgery.

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