July 29, 2009 -- Kelly Smith's attempt to go up a bra size when her 15-year-old leaky saline implant needed a repair this winter left has her in a self-imposed house arrest.
Smith, 46, expected a few more admiring glances with her new curves. What she said she eventually got was a profile that looks like someone took a bite out of the bottom of an apple. Now Smith said she dreads anyone ever laying eyes on her bosom again.
"Oh, god, no. Oh no. Nobody will ever see me topless," said Smith of Kingston, Ontario.
Smith said her new size-D implants looked "fantastic" for eight weeks. But then a quarter-sized "bubble" appeared between her breasts. A plastic surgeon at the local hospital told Smith her saline implants were now tearing through her breast tissue, so Smith returned to her plastic surgeon to get the tears repaired.
"She [her doctor] took the bandages off, and when you're looking down, they look good. When you look directly at, or from the side there is no breast tissue underneath," Smith said.
Smith said she has canceled dates and been on anti-anxiety medication since the bandages came off on July 24.
"Once I saw what I look like on Friday, the only place where I've gone is my girlfriend's house," she said.
Breasts can mean a lot to a woman. A decade ago, breast cancer survivors including Johns Hopkins' breast cancer educator Lillie Shockney went as far as to testify before Congress to prove the point.
Shockney and others eventually won a fight to get insurance companies to cover breast reconstruction after a mastectomy. The procedure had not been covered, even though Reconstruction after testicular cancer already was by most insurers.
Nearly 80,000 women underwent breast reconstruction surgery and 307,230 women chose to get breast implants for cosmetic reasons in 2008, according to the American Society of Plastic Surgeons. Those numbers may be an underestimation, since they only include surgeries performed by members of the ASPS and not all the doctors in the country.
Plastic surgeons say slight revisions are common and serious permanent eyesores are rare. Indeed, a small fraction of women -- about 20,000 -- who got breast implants in 2008 decided to have them removed. However, when something goes wrong in plastic surgery only so much can be done.
"Nobody can promise you you're not going to have a complication with a surgery," said Dr. John Canady, the president of the American Society of Plastic Surgeons. "If somebody promises that to you, you should talk to somebody else."
Preparing for Plastic Surgery Mishaps
Canady recommends talking to several doctors before choosing one, and to be sure to do your research before committing to a doctor. Even if an unsightly complication happens, Canady said there is some hope.
"Things can be made to look better. Scars cannot be completely erased but they can be made to look better," Canady said. "As important as what can actually be done, is to make sure the patients have reasonable expectations to what can be done."
However, for people living with unwanted features, psychologists who specialize in body image issues say it's unrealistic to think opinions about bodies can be excised from our self-esteem.
"It affects people tremendously. Body image -- even if it's one feature you don't like -- can have a huge impact," said Amy Flowers a psychologist in private practice in Macon, Ga., and a member of the American Psychological Association.
"Are they going to get fired? No. But certainly it can affect dating," Flowers said. "It can prevent people from applying for jobs and taking new risks."
Flowers said some psychologists hypothesize that at least one-fourth of a person's self-esteem is based on how he or she perceives his or her body.
"I don't think that you can have fabulous self-esteem and hate that part of your body that much," she said.
But Flowers points out that most of the negative effects of having a poor body image are actually self-imposed. Flowers said she has had patients with severe disfigurements who lead relatively happy lives, while others with small imperfections that they perceive as large suffer greatly.
"We see ourselves differently than the way other people see us," said Flowers, who explained that siome individuals tend to obsess about a flaw while others tend to see the person as a whole.
Less than a week after her operation, Smith cannot stop focusing on her situation.
Overcoming the Shock of Plastic Surgery Gone Wrong
"She [Smith's doctor] is telling me that they're going to fall -- I'd like to know where they're going from, because she has removed that tissue," Smith said.
A request for an interview with Smith's doctor, Dr. Kim Meathrel, who works in private practice in Kingsron, Ontario, was not returned.
After a quick look at her photos, plastic surgeons in the United States thought Smith might have a chance to look better.
"I suspect that she could get dramatic improvement," said Dr. Malcolm Roth, vice president of Health Policy and Advocacy for the American Society of Plastic Surgeons.
Roth said even with the best outcomes on the first try of plastic surgery, doctors need to pay attention to a patient's psychological state and expectations.
"One of the key issues is just being realistic, it's partly the responsibility of the surgeon," said Roth, who pointed out that the larger the implant the bigger the risk for complications.
"It's not that you shouldn't have implants that are that large. But eyes wide open," Roth said.
No matter what the results, Flowers said there are steps patients can take to improve their body image.
"It's focusing on what your body does well," Flowers said. "It's focusing on the parts of the body that you like."