Your Best Breasts

by Karen Burge and Beth Howard

Here's the latest information on nips and tucks—whether you're considering surgery for aesthetic or postural reason—and a guide to choosing the right bra for your lifestyle.

Surgical Enhancement

A life well lived leaves traces on your body: laugh lines, crow's feet, and, yes, breasts that aren't as firm as they used to be. One perfectly good reaction: shrugging at the changes—especially if you're shrugging in the right bra. But for some women, that gesture doesn't have the desired oomph, so they seek out gravity-defying or volume-reducing surgery. Prevention explores the perks and downsides of nips, tucks and other breast procedures.

Lift

Some women might opt for surgery to lift the breasts, adjust any sag and increase firmness.

How it works: Your surgeon removes any excess skin, thereby tightening the surrounding tissue and lifting the breast back up into a round shape. Dr Steve Merten, chair of the New South Wales chapter of the Australian Society of Plastic Surgeons, says newer techniques in both lifts and reductions result in less scarring. "The traditional breast-lift or breast-reduction scar pattern was an anchor shape. Modern techniques, which aren't for everyone, create a lollipop shape—around the circle of the [nipple's] areola and then vertically down to the bottom of the breast but [leaving] no scar underneath the breast."

Downside: The procedure can't replace lost volume, so if breast deflation is a big issue for you in addition to sag, a lift may not create the effect you want. Also, scarring and the risk of losing sensation in the nipple, which occur in approximately 15 per cent of patients, are two areas that concern many women, Merten says.

Reduction

The health impact of large breasts can include skin chafing, back and neck pain, shoulder grooves from ill-fitting bras and postural problems. A surgical procedure can reduce the size and volume of the breasts or combat sagging. A recent study showed that this surgery greatly reduced or eliminated discomfort one year after the operation for 88 per cent of patients.

How it works: The surgery removes breast tissue, repositions the nipples and recontours the breasts. As with the breast lift, newer techniques leave smaller scars, which the nipple's areola can neatly camouflage, although many factors determine whether this approach or the older 'anchor' lift is right for you. Your doctor can talk you through these options.

Downside: In some cases, the operation can cause a loss of nipple sensation.

Breast Implants

Implants replace lost volume and reduce sag by lifting the breasts.
How they work: A 1994 study from Washington University School of Medicine (Missouri, US) found that 95 per cent of women felt better about themselves after breast-implant surgery. But implants present a tough choice: saline or silicone? Saline is basically sterile salt water, and silicone (which was recently out of favour but has since staged a comeback) is a sticky gel. "The current silicone implants are a gel of almost Turkish-delight consistency, so in the worst-case scenario, where one tears or breaks, the silicone just stays where it is—it doesn't go anywhere, which is different from traditional liquid implants," says Merten.

Downside: About 10 per cent of implants, saline or silicone, rupture within 5 years, and this rate goes up as time passes. Implants can also harden—it happens with up to 80 per cent of silicone implants and 40 per cent of the saline variety. In addition, a study from the University of Washington in the US found that mammograms missed 55 per cent of breast cancers in women with implants, versus only 33 per cent among women without them. But Merten says it all comes down to having your mammogram done at the right facility. "I tell my patients to go to radiology places that know how to screen [women] with breast implants. In these settings, there's probably very little, if any, difference [in breast-cancer detection]."

New Developments

Surgery-free boost: Macrolane is a gel-like breast filler made from hyaluronic acid; a practitioner injects it deep into the breast tissue to create a fuller shape. Australia's Therapeutic Goods Administration hasn't yet approved the product, but it's currently on the horizon as a potential alternative to permanent surgical enhancement.

PLUS Your Guide to Finding the Right Bra

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