How big is too big? Breast implants and size

I was browsing some of the breast-implant related sites Implants411, implantinfo,
Yes, They're fake!, etc... this past weekend and had a few thoughts.

What's being played out to me on many of these bulletin boards is some poor educational efforts by the surgeons these women are consulting with. I'm really taken aback by the size and location (subglandular position) that many of the participants in those forums are reporting that they've had done or been recomended to have done. What I don't think is being adequately represented to these women are the long-term consequences of large implants on their tissue. 5' 6" 120 lb women do NOT need 500cc implants and that just appears to be too common a reported scenario.

Predictably what we (Plastic Surgeons) are going to be creating is an attenuated skin envelope with potentially irreversible or difficult to correct deformities. This is the nexus of patient's obsession with size colliding with a cosmetic surgeons desire not to alienate a potential client. The debate about which master we serve with breast augmentaion- the patient's desire or the patient's best interest is a debate that has generated a lot of controversy. There was a particular nasty spat in the letters column of
Plastic & Reconstructive Surgery (our flagship journal)last year on this topic with alternating charges of wrecklessness versus (allegedly) paternalistic attitudes towards patients.

Having done a fellowship in breast surgery heavy in revisional surgeries, I'm more and more convinced that we (as a specialty) deserve an F (or a least a DD :) )on our communications in this area.


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