Fake is out, natural is in

So, has it become passé to have a boob job? Actually, no, breast augmentation is more popular than ever. Cape Town cosmetic surgeon, Dr Stuart Geldenhuys, talks about the trends, pros and cons of breast augmentation in the 21st century.

According to the ASAPS (The American Society for Aesthetic Plastic Surgery) 2010 statistics on cosmetic surgery, there has been over 155% increase in the total number of cosmetic procedures since 1997 ( Surgical procedures increased by more than 71%, and nonsurgical procedures increased by 228%). The top cosmetic surgical procedure in 2010 in America was breast augmentation (318,123 procedures).

The difference between the old and the new is in the size and shape. Gone are the Pamela Anderson twins, and instead the catwalks and red carpets are filled with breasts that look like they were born that way – perfectly pert, but naturally rounded and but not too big.

Breast augmentation, also known as an augmentation mammaplasty, breast enlargement or colloquilly boob job, is the most commonly requested surgical procedure, with an extremely high overall satisfaction rate.

“Breast augmentation was about enlarging breasts – Shaping and proportion are now our priorities, and size is purely a consequence of these choices,” explains Geldenhuys.

“A patient needs a result that in twenty years will still be appropriate and look good – a natural result is proportional, has a gradual slope to the upper half of the breast, full rounded lower pole with focus and projection of the nipple aureola complex, noticeable cleavage with soft transitions between the breast and chest wall. Adequate tissue cover will ensure that neither the implant margins nor rippling will be visible and along with an appropriate sized implant will limit any long term breast tissue thinning or sagging.”

Why are celebrities having their implants removed?

Dr Geldenhuys believes that in many instances, women who have implants removed or redone, may have made bad or uninformed choices - either having chosen breast implants disproportionately large in relation to their frames and which have caused breast tissue to thin reducing the soft tissue cover or stretching of the breasts with sagging or they have experienced capsular contracture or visible rippling.

“Breast augmentation techniques have become more sophisticated since the first implants were done – as the emphasis on long term outcome and breast stability is paramount prioritising adequate soft tissue cover, dual plane, sub-muscular pockets and the use of anatomical shaped implants are becoming more commonly performed to provide durable and natural results,” comments Geldenhuys.

Refinements in surgical and anaesthetic techniques along with major advances in breast implant technology have and will continue to impact favourably on the safety and reliability of the procedure.

The quality of silicone implants has significantly reduced the risk of leakage, rippling and capsular contracture.

Anatomical implants have been developed to create a more natural silhouette - a smooth, sloping upper breast pole without excessive roundness, and generous fullness of the lower pole providing nipple projection. In addition, anatomical implants come in a wide variety of heights, widths and projections allowing custom tailoring to a patient’s body proportions.

The trend is towards using more naturally shaped implants, to create a more natural breast shape. What is interesting to me is that in SA anatomical implants are used in less than 15 % of all primary breast augmentations. The implants are however more expensive. The use of anatomical implants requires a more systematic approach to breast augmentations. Breast and the chest wall measurements define choices rather than just an artistic eye. Furthermore the surgery requires more precise execution.

An anatomical implant is not essential in all cases to create a “natural” breast shape.

However, a comprehensive evaluation of breast shape, tissue and chest wall characteristics will determine the optimal implant shape to achieve the desired breast shape.

Are there any other options?

Using a patient’s own fat or fat grafting of the breast, is a relatively new technique of breast augmentation. With this technique, modest size increases with a soft natural breast and breast shape can be achieved without the use of implants.

The question still remains – is it pure vanity to have breast augmentation done and in an age where all things natural are being celebrated, why would women resort to artificial means to enhance their looks?

It could be argued that breast augmentation is no different from having orthodontic work done or having your hair highlighted and wearing beautiful clothes to feel good.

However, Dr Geldenhuys says that aside from reconstructive surgery following breast removal, the benefits of elective breast augmentation are often extremely beneficial to a women's self-confidence, sensuality and sense of well-being.

“We live in an era of medical and technological advancements that allow us to optimise and remedy aspects of ourselves we are uncomfortable with,” says Geldenhuys.

According to Dr Geldenhuys, the most common reasons women have breast augmentation include enlarging the breasts to make the body more proportional, reshaping and enlarging breasts that have lost their shape and balancing breasts that differ in size or shape.

Often after pregnancy and breast-feeding, breasts lose both shape and volume. Women with small or sagging breasts find it difficult to buy underwear or swim wear. In some instances, failure of breasts to develop, unevenly developed or tuberous breasts make young women extremely self- conscious.

“Essentially it’s about how you feel about your body – if you are comfortable with your shape, no matter what type of breasts you have then plastic surgery is not for you, but if the size and shape of your breasts are negatively impacting on your self esteem, then plastic surgery can make a major difference.

“However plastic surgery is not a cure-all – I do not operate on women with body dysmorphia, or who are doing it to please their partners or who see plastic surgery as the solution to all their relationship and psychological problems.”

Dr Geldenhuys emphasises that there is a direct correlation between the satisfaction rate for breast augmentations and a patient having realistic expectations and a positive attitude to life. So plastic surgery is still “in”, but it’s more about the natural enhancement of your assets.

(Press release, September 2011)

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