dailycamera.com
By Mary Butler, Camera Staff Writer
May 23, 2005

Breast Intentions: Adjustable Implants Gain Attention as More Women Seek Augmentation

When he's asked why so many women today seek out breast implants, Englewood plastic surgeon Ben Lee puts it bluntly:

"A lot of young women don't know what a natural breast is supposed to look like anymore," he says. And what's more, Lee says, after undergoing breast augmentation, most woman want their breasts to be even larger.

"When I was growing up, the saying was, 'Whatever fits into a champagne glass.' That would not be the ideal breast today," Lee says. "In Denver-Boulder, that ideal would be a C-cup, with a little bit of upper fullness and a nice smooth, round contour."

In recent months, Lee has started using adjustable breast implants, which allow a patient to go up or down a cup size within six months of surgery, to meet the needs of patients who are unsure of how large they want to go. Typically, the decision is made after swelling from the initial surgery has subsided - after about a month - and once the filling ports are removed, the implants' volume can no longer be changed.

One of Lee's patients, who asked not to be named, had the procedure done in October.

She was the perfect candidate, unsure of whether going up one cup size, from a smallish A cup to a B cup, would be enough.

Like so many breast implant patients, the woman, a 30-year-old graphic designer in New York City, decided she wanted to go larger - to a C cup - after the swelling from surgery subsided.

"It was a scary feeling, because I was changing something about my body," she says. "But I feel like I look good. I don't feel like I look disproportionate at all."

And the 5-foot-7, 125-pound woman says she's glad she only had to undergo one surgical procedure, unlike an acquaintance she knows, who recently went back under the knife because she was dissatisfied with the original size she chose.

"To me, that just sounded awful," she says. "This was a totally good way to go."

Adjustable implants were pioneered in the mid-1980s by two Florida plastic surgeons, Drs. Hilton Becker and Myron Persoff. But few doctors have taken advantage of the flexibility of the saline implants, made by Santa Barbara, Calif.-based Mentor Corporation. Many doctors prefer the more conservative approach, saying with every added step in surgical procedures come added possibilities of complications.

More typically used are "fixed-fill" implants, which are filled with saline during surgery to a specific level and can't be changed after the operation. With adjustable implants, a 1/8-inch-diameter filling tube is left inserted in the implants and brought out between incision stitches, allowing a final determination of size to be made later.

Lee says he anticipates fixed-fill implants will remain the norm. But with demand for implants growing - there were 334,000 implant surgeries in 2004, up from about 101,000 in 1997 - the demands of patients are growing, too. The American Society for Aesthetic Plastic Surgery says breast augmentation is the second-most popular cosmetic procedure for U.S. woman; liposuction ranks first.

In fact, implants now are influencing the sizes designer stores carry in augmentation capitals - Southern California, Texas and Florida - because women are desperately seeking clothes to fit their more ample upper halves. For instance, the Beverly Hills branch of upscale retailer Neiman Marcus sells more dresses in size 12 than any other, while sizes 8 and 10 are the most popular for designer evening wear at other stores, according to a recent New York Times News Service story.

Adjustable implants, Lee says, are a good option for some patients who are wavering on size, women who are also seeking a breast lift at the time of augmentation and women with narrow breasts who are seeking a fuller look.

Many women seeking breast implants have recently finished childbearing and want to regain the fullness and buoyancy their breasts lost with breast-feeding and age, he says.

Lee, 40, who's been practicing plastic surgery in Denver for seven years, says he didn't try the implants until a patient requested them. Now, he says he plans to recommend them to people he thinks will benefit from the implants' flexibility.

Dr. Scott L. Replogle, a plastic surgeon in Louisville who's been in practice since 1983, says he's skeptical of the procedure, given the reliability of fixed-fill implants. Why mess with a good thing, he says.

"In average augmentation, the goal is to get what you expect and have it be one time and not have to fiddle with it or worry about it," Replogle says. "You can still changes sizes, but you have to take one implant out and put in another."

His biggest concern, Replogle says, is in compromising the integrity of the implant's shell. "Modern saline implants are engineered to last a lifetime - they don't wear out like tires. But they can fail," he says.

"Saline implants are not engineered such that you can really adjust their volume over a broad range and have them be ideally filled," he says. "With the filling mechanism, if you have anything that has a valve or something you put in or take out, you have a higher risk of having complications."