Adjustable Breast Implants -- a Boon for Busts?

What if you could change the size of your breasts at will?

For women with adjustable breast implants, having bigger -- or smaller -- breasts is an option, at least for the first six months after surgery.

And the adjustable nature of these devices could help many women who haven't quite decided whether to go Pamela Anderson big, or adopt a svelter Gwyneth Paltrow silhouette.

"Women get a false idea of what size C or D is because each bra manufacturer is different," said Dr. Thomas Jeneby, a plastic surgeon in San Antonio, Texas. "You don't really get into patients' mind-sets until after the surgery."

Adjustable implants allow for small changes in breast size after the surgery -- women can go up to 20 percent bigger or smaller, on average.

More than 364,600 women had breast implants put in last year, according to the American Society for Aesthetic Plastic Surgery. However, relatively few opted for the adjustable variety.

Doctors Make Adjustments

There are two main types of adjustable breast implants. One is composed entirely of saline, and the other has a saline core and a silicone shell.

A few months after the surgery, after women have had the chance to "test drive" their new bosoms, they can go back to their surgeons to request that their breasts be pumped up or toned down.

The surgeon will then use a syringe to either inject saline into or draw saline out of the implants through a port hidden beneath the skin where the implant was originally inserted.

"The breast area is usually too swollen during the first two months after the surgery to tell what the final breast size will be," said Jeneby. "The swelling goes down after that period, and patients can see if they are satisfied with their sizes."

The adjustable implants offer a simpler alternative to complete replacement of implants with those of a different size.

With nonadjustable implants, "if patients are unhappy with their size, there are no options other than redoing the surgery," said Dr. David Watts, director of the Plastic and Cosmetic Surgery Institute in Philadelphia. "With adjustable breast implants, you can adjust the implant size postoperatively, up to 20 percent of its original size."

The port doesn't stay in the patient's body forever. It is removed six months after the surgery through an outpatient procedure done under a local anesthetic

"It's a fantastic way to control your breast size postoperatively, because people do change their minds," said Jeneby.

Benefits Overinflated, Detractors Say

Not all plastic surgeons are excited about the idea of adjustable breast implants.

"Although the concept of adjusting up or down by a cup size sounds great, it isn't practical," said Dr. Ronald Friedman, director of West Plano Plastic Surgery Center in Plano, Texas.

"Only a limited amount of adjustment can be done before one should step up to a different size implant," said Dr. Darrick Antell, a New York City plastic surgeon and a spokesman for the American Society of Plastic Surgeons.

"With saline implants, you can add approximately 20cc to 30cc. If you go beyond that, you can get deformation at the perimeter of the implant."

"Implants are designed for a specific, narrow range of filling volumes," said Friedman. "If implant volume is reduced to below the manufacturer's recommended volume, the risk of deflation increases. If implant volume is significantly increased, the implant will become unnaturally firm."

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