Dec. 26, 2006 -- 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."
In addition to limited adjustable volume, the extra port attached to these implants can become a potential source of discomfort and complications.
"There might be a problem of disengaging the tube from the implant because of the scar tissue that may form in that area," said Antell.
"Few of my patients would be accepting of a filling port placed just beneath the skin," Friedman said. "These ports are quite hard -- think metal and rubber -- and are sometimes uncomfortable."
"The exact risk of infection is unknown but is increased if a port is used," said Dr. Brent Moelleken, clinical assistant professor at UCLA. "How would a woman feel if she developed an infection in her breast implants and had to have them removed just because she wanted to be 30cc larger?"
But the draw of adjustable implants seems to appeal to certain patients.
"If the [adjustable implants] are offered to a patient and the advantages are explained, out of the last 102 patients last year, 100 of them have opted for having adjustable breast implants," Jeneby said. "Patients absolutely love them. I don't know a single person who has had a negative comment."
"The procedure is very safe in my opinion," said Watts.
Not Everyone Has Adjusted to the Idea
But if adjustable breast implants are such a great idea, why aren't they widely used even though they have been available for a while?
"Surgeons are used to doing regular implants, and they haven't learned how to use adjustable breast implants yet," said Jeneby.
While surgical inexperience with adjustable breast implants may be part of the reason for their limited use, many surgeons worry about added risks associated with these implants.
With adjustable breast implants, "the increased risk of implant deflation due to valve failure, and dysfunction of the filling port must be considered," said Friedman.
"Ideally, the size of implants should be determined in advance of the surgery, based on the woman's dimensions and size requirements," said Moelleken. "The best results are obtained from an implant that is filled to the optimal amount, not underfilled or overfilled. Why not put the right size to begin with?"
Regardless of what kind of implants a patient chooses, though, open communication between doctor and patient is crucial.
"There is no substitute for a candid discussion about desired breast implant size prior to surgery. Your first shot is your best shot," said Friedman.