Boomers and the bust
	By Dr. Anthony Lockwood M.D., F.R.C.S.C. www.thefirstglance.ca View Dr. Lockwood's profile

HEALTH Canada held a public hearing in September of 2006 to entertain concerns about the safety of silicone breast implants and to decide if it was prudent to lift restrictions on their use. I was present at the hearing and listened to the evidence; both scientific and anectdotal, for and against.

In Canada for the past four years, with the written permission of Health Canada, plastic surgeons have been able to use silicon implants again after the U.S. Food and Drug Administration’s moratorium severely restricted their use in 1992.

Silicone gel breast implants have been scrutinized more than any other medical device in history. Curiously, to my knowledge, silicone testicular implants never received the same scrutiny or restrictive litigation. After years of exhaustive studies in North America and Sweden, both Health Canada and the FDA have lifted the restrictions on the devices. One of the recommendations of Health Canada, however, was that the devices be implanted by plastic surgeons with the prerequisite training.

Cosmetic breast augmentation, or what is colloquially known as a “boob job”, has increased in popularity steadily since the 1990s “silicone scare”. It now ranks second only to liposuction as the most popular cosmetic surgical procedure in North America, with over 300,000 women receiving new implants a year. There are now over two million women with implants in North America.

With this popularity, and with the wealth of misinformation in the wake of the scare, I would like to discuss some the benefits and risks inherent in their use, and patterns I see in my cosmetic surgery practice.

First of all, all implants contain silicone: either in the shell, or in the filler gel. The shells are tougher and less likely to leak free silicone than the devices of the 70s and 80s but they can break and they can wear out. The lifespan of a device can be anywhere from 10 to 30 years, but they should be closely reassessed every 10 years, and checked annually by the surgeon who placed them.

Silicone implants do make it harder to perform and assess X-ray exams. MRI scans and ultrasound tests are helpful, but if there is a strong family history of breast cancer, or a woman tests positive for the gene associated with breast cancer, then I would have reservations about the surgery.

With all implants, there is a degree of fold wrinkling or palpable or visible rippling; especially with a smaller breast to start with, and with saline (saltwater filled) implants more so than silicone gel. There may be an imbalance in size or shape from one side to another, and sometimes the implants may shift, rotate, or flip over. With infection, or with a long period of time, there may be a gradual hardening of the implant from surrounding scar tissue, making removal or replacement necessary.

A woman may nurse with implants. With successive pregnancies and aging, breasts will change, lose volume and sag; breast implants are not a lifetime choice.

The benefits of silicone breast implants include a more natural feel than offered by saline.

Studies demonstrating an improvement in confidence, self-esteem and a more positive body image are well documented. In February, 2006, a study was published in the Aesthetic Surgery Journal that demonstrated that in those undergoing cosmetic surgery, the greatest benefits in improvement in body image and sexual satisfaction were seen in women undergoing breast augmentation. Breast augmentation may make one’s figure more proportional and allow one to wear more flattering clothing.

It is important that a woman’s expectations are realistic, that she has the time to educate h erself about her choices, and she has enough time to choose the size that meets her desires. In the old days, implants were limited to round shapes and limited number of sizes. Now, I have 30-plus different shapes of saline and gel implants to choose from, with 10 different sizes in each.

Choosing the right size and shape for a person is a lot more involved. Someone who is five foot, nine inches tall requires a much larger implant to move up one bra cup size than someone who is five foot, two inches tall. If someone goes from a small B cup size up to a DD cup while nursing, then deflates down to B again after breast feeding, then there will be more loose skin and sagging.

With the newer Cohesive gel or “Gummy Bear” implants, one gets more lift effect for sagging breasts than with saline or regular gel implants. The firmer tear drop shaped gel implant will give support and shape.

The breast will redrape over the implant like a dress over a mannequin. Five years ago my practice was 99 per cent saline implants to one per cent silicone gel, with a higher proportion of younger women 18 to 28 who hadn’t had children. Now my breast augmentation practice is 90 per cent Cohesive silicone gel to nine per cent regular gel, and one per cent saline.

There are three groups of women interested in implants: 30 per cent are 18 to 28 with no kids; 55 per cent are 30-something with two or more kids; and 15 per cent are boomers, who are 50 and older. My boomer generation is interesting; they are not willing to age gracefully. They tend to be professionals, competitive, and often have younger spouses.