US Newswire
1/20/2005 11:46:00 AM

Big Business: Breast Augmentation still booming

Women who want the 'Baywatch' look a small fraction of patients Who undergoes the knife?

By SHARI ROAN
Los Angeles Times

If all goes well, Akinyi Okoth, a single, 32-year-old New York City woman, will come home from a lengthy vacation later this summer with the breasts she has long wanted.

Like one-quarter of a million U.S. women each year, Okoth plans to have her breasts enlarged with implants. She has always felt unfairly shortchanged when it comes to her breast size, she says, pointing out that her sisters are well-endowed. Besides, she thinks clothes look better on bustier women.

''I feel good about myself, but I think breast implants will make me look better and change the way I think and act,'' says the information technology professional.

The Food and Drug Administration is still considering whether silicone gel implants -- such as saline implants -- are safe for general use in augmentation, but for Okoth, it's a moot point. She's made up her mind to obtain what nature itself didn't create.

Her determination underscores a point that often has been overlooked in the debate over the safety of silicone implants, pulled from the market 13 years ago: U.S. women want augmentation, silicone or no silicone.

Even as public health officials, breast manufacturers and anti-implant activists have been warring over the risks of silicone implants, more women than ever are paying the price -- and taking the risk -- to have perkier or bigger breasts.

Sometimes the changes are subtle, noticed primarily by the woman herself. Often they're obvious, meant to be noticed by almost everyone. In any case, augmentation no longer carries the stigma it once had.

In 1992, the year silicone implants were banned for general use, an estimated 32,607 women underwent augmentation -- elective surgery to enhance breast size. Since then, augmentations have soared to an estimated 252,915 a year, according to the American Society of Plastic Surgeons.

''Breasts sell,'' said Ann Kearney-Cooke, a Cincinnati psychologist who has studied body image. ''Whenever you have a body part that there is such a high charge around in the culture, I think that is when you see people getting obsessed and dissatisfied.''

In part, the popularity of augmentation surgery can be traced to the growing overall acceptance of plastic surgery. Cosmetic procedures have increased 26 percent since 2000, the plastic surgeons group says.

''The whole idea of remodeling your body has become a fashion statement, almost like changing your wardrobe,'' says Rita Freedman, a clinical psychologist in Harrison, N.Y., who has studied body image and breast implants.

The rounded, high profile of implants might not be normal, but they can seem to be the norm. In some social circles, there even might be pressure to conform.

''It's the fashion to have done it rather than not to have done it,'' says Freedman. ''People used to go to South America and have it done in secret. Now people come back after surgery almost bragging about what they've done.''

Studies show that women who desire implants are more concerned with their appearance than the average woman, says Kearney-Cooke. The 2003 survey found that the most popular reason for seeking augmentation -- stated by 91 percent of women -- was to look better without clothes.

But, she adds, augmentation patients often experience a more positive outlook on life after the surgery. ''Feeling attractive and feminine and sexy is healthy for people. When you feel that way, that's a great energy.''

Freedman doesn't buy the argument that women seeking augmentation are doing it solely for themselves and their self-esteem.

''Nobody does this just for themselves,'' she says. ''The decision that seems to be your own is a product of what you've learned from the culture. The youthful, high, pointed breasts that have been revered as the perfect breasts have been learned from the culture.''

She suggests that societal pressure to look good has overtaken concerns about safety. Both silicone and saline implants can harden and rupture, requiring surgical removal. Infections can occur after surgery. Implants can cause a lack of sensation in the nipple, impair lactation and complicate mammography.

Evidence that the silicone devices in particular could rupture and cause health problems prompted restrictions on their use. Although studies largely have ruled out a link between silicone and serious illness such as autoimmune disease, questions remain about the long-term safety of silicone implants and how often the implants break.

In the years since the moratorium, most of the implants used in this country have been filled with saline, although silicone implants are still available to women who've had a mastectomy, who are part of a clinical study or who are replacing implants.

Dr. Steven Teitelbaum, a Santa Monica plastic surgeon, says most women have concluded that the benefits outweigh the risks. Women will have no qualms about choosing the cosmetically superior silicone implants for augmentation should the FDA lift the moratorium, he and other plastic surgeons say. More than 90 percent of women in Europe, where both silicone and saline are available, choose silicone.

Many women seeking augmentation are annoyed that the matter is still being debated. Silicone implants simply look more natural and feel better than the saline versions, they say.

Even if the FDA maintains the moratorium, it probably won't slow the pace of augmentations. The 2003 survey found that 94 percent of augmentation recipients would recommend the procedure to friends or family.

Okoth is prepared. If the moratorium is continued, she'll probably fly to Brazil to undergo augmentation surgery there. Silicone implants are legal in that country.

''But I should be able to make the choice,'' Okoth says. ''And everything I've read says silicone is better.''