Beat The Booby Traps

Posted: Tuesday 4 May 2010 10:49am

In the early 90s, a very pretty but otherwise unremarkable young blonde became an international pin-up sensation for her role in an unremarkable TV show, Baywatch. This show also became an international sensation, it could be said, on the back of this young blonde’s front.

When describing Pamela Anderson as otherwise unremarkable, that’s not entirely fair: she did have an extraordinarily large pair of breast implants for her tiny frame, and which filled out her trademark red swimsuit spectacularly. These implants (albeit different sizes over the ensuing years) have been at the front and centre of her notoriety ever since.
It’s a gimmick that has worked similarly well for other ambitious young wannabes; for instance, British glamour model Jordan (now better known as Katie Price) and US TV celebrity Heidi Montag, of The Hills. Heidi now boasts breasts that resemble bowling balls, one of 10 cosmetic surgery procedures she had in a day to morph into a Hugh Hefner girlfriend clone, whether or not that was her intention.

Both women, as Pamela, have had hugely inflated media coverage in proportion to their actual achievements. That’s showbiz, and it worked for them.
However, as they say, it’s recommended you don’t try this at home and the vast majority of Australian women seeking breast implants do not.
“Heidi [Montag] looks like she has two very large, ultra-high projecting round implants which are too wide for her chest,” says plastic surgeon Dr Michael Miroshnik, of Sydney’s Double Bay.
“They give her a very ‘operated on’ look, which certainly engages the media and male fans alike but they simply aren’t what normal breasts were ever meant to look like.
“In my experience, approximately five per cent of patients want this type of very artificial look. However, in Los Angeles, I’m sure the proportion is much higher.
“The average Australian woman wants to look quite natural and realistic. More often than not, patients tend to bring photos of [celebrities] they DON’T want to look like!”
The image created by implants-as-career-move misrepresents the profound emotional and psychological reasons most women seek breast augmentation.

Who has breast augmentation
“There are two broad groups of ‘typical’ patients,” says Dr Miroshnik. “One group is women in their early to mid-20s, nulliparous [have never given birth] and who want to enhance their appearance. They want more volume, more cleavage, more upper pole fullness. They basically want to look spectacular in a bikini – especially those who live near beaches. This group tends to go for the larger, high projecting round implants.
“The second group comprises women who are a little older, have had children and, after breastfeeding, want to restore the volume they have lost. This group usually wants to look uber-natural and may often need a degree of lift too. They tend to go for anatomical (teardrop) implants.”

The bad old days
In the 90s and early noughties, a far more insidious wave of publicity about breast augmentation emerged; class action lawsuits brought by women whose silicone implants had ruptured inside their bodies and, according to court documents, caused devastating longterm health problems, such as auto-immune diseases.
Many stories also emerged of women suffering excrutiating pain and disfigurement caused by capsular contracure. (This happens when the body forms a lining of tissue, or “capsule” around breast implants, as it does with any foreign object placed in the body. In some people, the capsule will tighten and squeeze the implant, distorting the appearance of the breast and making it feel hard.)
Women came forward telling horror stories of doctors who would “crush” the breast to break up the hardened tissue and in so doing, cause agonising pain and in some cases, the implant to rupture.
The lawsuits and negative publicity caused a backlash against implants for some years and created great suspicion about their safety.

Newer, safer technology
Today the landscape is very different and demand for breast implants is on the increase. “Implants don’t leak anymore [due to use of high cohesive gel],” says Dr Miroshnik, “and capsular contracture rates are about 10 per cent at 10 years [after surgery] for high cohesive silicone gel implants and are reported as low as 1 per cent at 10 years for polyurethane implants, but these have other downsides.
“Silicone breast implants have been around for almost 50 years now so understandably they have improved by great leaps and bounds,” says Dr Miroshnik of the contemporary climate.
“We are now up to sixth generation implants, which contain what is know as a high-cohesive gel. You can liken this gel to a thick Jello mould – even if the whole shell was removed it would still stay put in the same position and not move. Therefore, it is very safe.
“This is in sharp contrast to older generation low-cohesive silicone filled implants in which the silicone gel was more like honey and would leak out, contaminating the surrounding tissues if there was an implant rupture.”

Who should, who shouldn’t …
Unrealistic expectations of what can be achieved or of what implant shapes and sizes are appropriate for their bodies, and motives for surgery that are not necessarily in the patient’s best interests are also factors that can be put in the potential “risk” category.
“I try to divide motivating factors for those seeking cosmetic plastic surgery into internal and external groups,” says Dr Miroshnik.
“Internal motivators are those women doing it for themselves, to enhance their appearance and make themselves feel great. They have often been thinking about it for a while and are very clear in what they hope to achieve from their surgery. From a plastic surgeon’s perspective, these women make the best patients and luckily form the majority of the patients we see.
“Conversely, external motivators are factors such as partners and careers, which give patients the incentive to seek surgery they would otherwise not be interested in. This is a smaller but dangerous group, because if the external motivating factors are not rectified by the procedure then these patients may not be happy. For these patients, surgery may not be the answer.”
To achieve the ideal breast shape and size for an individual patient, Dr Mirsohnik describes it as “a little bit like dress-making …once I make all the measurements it becomes entirely clear when a certain size would look quite wrong for that particular person’s body.
“By educating women in this way, I find most will tend to agree with me by the end of the consultation. I tend to spend a good hour with women on that first consult explaining the process and most by the end of it we are on the same wavelength.”

>> Read Dr Miroshnik’s article about Advances in Breast Augmentation

by Jenni Gilbert

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