By her 18th birthday, Laura Kearney realized "the girls" weren't growing -- but she pushed aside thoughts of breast implants.
For eight years, she resisted the pressures of society -- images of stars and starlets, the focus on female anatomy. "It's everywhere in your face," says Kearney, now 26. "I felt like less of a woman."
In the end, Kearney finally did do it -- tossed the padded bras forever, opting for silicone breast implants. "It may seem petty to some people, but felt I needed to do something about it," she tells WebMD. "I didn't get a drastic implant, just one that suited me. I didn't want it to be, 'Look what she did.'"
The results? "I can't believe how real, how natural they look," Kearney says. "I can't even describe how happy I am."
In fact, she adds, the preparation for breast implant surgery pushed her into a healthier lifestyle. "I got into the vitamin regimen, quit smoking. It was a big opportunity for me to be a healthier person. It felt like everything was going in the right direction. It was so exciting."
Breast Implants: Expectations vs. Reality
Breast augmentation -- breast implant surgery -- is the top cosmetic surgery performed today, according to the American Society of Plastic Surgeons. A total of 347,524 women had the surgery in 2007.
It's a major step for most women, and often a positive one. Studies have shown that breast implants can help boost self-esteem, body image, and sexual satisfaction.
But studies have also pointed to the critical need for careful screening by doctors, and self-awareness among women, before breast implant surgery. Women who may have psychiatric or alcohol problems before their surgery may be at higher risk of suicide years later.
Here are realistic insights from doctors and patients about the impact of cosmetic breast implants, and how to tell in advance whether implants may help you.
Breast Implants & Body Image
Laurie Casas, MD, associate professor of surgery at Northwestern University's Feinberg School of Medicine in Chicago, is a contributing author of a textbook on breast surgery.
Nearly half her patients are like Kearney -- young women whose breasts never developed, a condition called micromastia. "She had two nipples on a flat chest," she explains. "It looked like a prepubescent boy's chest."
She also sees young women who have developed asymmetrical breasts -- they don't match in some way, either in size or shape. It's a relatively common, embarrassing condition. One breast might be a D-cup, while the other is a B. Or there might be a half-cup difference between the breasts -- which might not sound like much, but can be very noticeable.
"They truly feel they have a deformity," Casas tells WebMD. "They don't feel they have a normal body part. It's a body image issue, not a self-esteem issue. They want that body part to look more normal, to look better in clothes and bathing suits."
All that rings true with Kearney, she says. "I look in the mirror now and think, 'That's the way I'm supposed to look.' I have more confidence now. I can go clothes shopping, and it's amazing how things fit."
Mommy Makeover & Breast Implants
Here's another of Casa's patients: 41-year-old Kristen Chase, who was "a generous 36B" before she had four children in seven years, she says. "After my fourth child, my breast tissue was just a deflated sack. My body bounced right back after the pregnancies, but my breasts didn't. I wanted my body back."
Women like Chase grew up with a completely different mind-set, says Casas. "They don't have body image issues. These women went through their formative years feeling good about themselves. They work out, feel great. They just want the breast to be the nice normal size they had before."
The first time Chase looked into breast implant surgery, silicone implants weren't FDA approved. With her broad chest, a saline implant just wasn't appropriate. "It would have protruded too much," she says. "That was not the look I wanted."
Her result with silicone? "It's very natural, not an artificial breast look, not the type you see on the street and know immediately is a fake," she says. Another key point: "I've had zero sensitivity loss in my breasts."
Breast Implant Replacement & Other Realities
Women who’ve had breast implants and their doctors agree: It’s very important to go into surgery understanding the full financial costs -- or you’re bound to be dismayed.
- Health insurance does not cover the surgery.
- Insurance also does not cover any follow-up surgeries. Yet complications do occur, and revision surgeries are sometimes necessary to correct a problem.
- Also, both saline and silicone implants usually have to be replaced at some point because of breakage.
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 they have 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.
Over the years, Rod J. Rohrich, MD, chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas, has come to recognize the patient with unrealistic expectations. "I want to do it if the patient is doing it for themselves -- not for their new boyfriend, or to save their marriage."
He won't treat patients who are going through major life changes -- divorce, death in the family, he tells WebMD. "I tell them up front it won't change your life, won't get you a new job, won't get you more dates. But it can make you feel better about who you are."
When Breast Implants Mask a Bigger Problem
When self-esteem and sense of self are more fragile, that's when people tend to have unrealistic expectations of breast implant surgery, explains Wellisch. "They are seeking transformation of sense of self. The gap between their ideal self and real self -- or the way they see themselves -- is greater than for the other group."
For these women, breast implant surgery is a band-aid approach to a bigger problem, he says. "They do feel better after this kind of surgery. I've seen it in my practice. But the surgery cannot transform a fragile or extremely vulnerable sense of self."
It's no surprise to Wellisch that studies show an increased risk of suicide among some women with implants, often 20 years later. Some women may hope that breast implants are a quick fix for mental health problems.
"It could be that the women have a psychiatric illness, then they feel better after the implants," says Loren Lipworth, ScD, an assistant professor of preventive medicine at Vanderbilt University, Nashville, Tenn., who worked on some of the studies. "Studies have certainly shown high levels of satisfaction and improved quality of life after this surgery."
But a decade later, the satisfaction fades for some reason, Lipworth says. "It may be that the psychiatric illness gets worse later on, or that it may develop later on. We don't know for sure."
Bottom line: Women need to be aware of this risk, she says. "A woman knows if she has a history of depression. She should be aware that depression can return.”
Good surgeons will help women assess whether their expectations and reasons for wanting breast implant surgery are realistic.
Rohrich turns away patients who make unrealistic requests -- recognizing it as a sign that they may have emotional problems. "I can't make a 5'1" woman into a D cup. Maybe that's what some want -- and they can always get what they want somewhere else. But I turn them away.”
Casas is also careful to screen for poor self-esteem and body image. "We stand them in front of the mirror. What do you see? They have to be able to see the real person, not who they think they are. If there are signs of body dysmorphic disorder, they need a true psychiatric evaluation and psychiatric support."