Breast intentions

PUBLISHED : Tuesday, 01 August, 2006, 12:00am
UPDATED : Tuesday, 01 August, 2006, 12:00am

MANY PEOPLE DISMISS cosmetic surgery as foolish vanity - until they develop their own complex. When I found myself sitting in a Central-based plastic surgeon's office, I knew I'd crossed a critical line in the quest for beauty.

I'm not alone. Breast surgery is becoming more popular globally - there was a nine per cent increase in breast surgery in the US last year and the British rates are rising steadily, too. According to Xinhua News Agency, more than one million mainlanders had cosmetic surgery in 2004 - three times the number for the previous year.

The latest figures for Hong Kong were released by the International Society of Aesthetic Plastic Surgeons (Isaps) last year. It said the city ranked 25th globally for the number of cosmetic procedures in 2003: 3,634 procedures by Isaps members, compared with 85,635 in the US.

And, after much deliberation, I made the decision to join them.

Pre-op consultation: I was dreading this. My breasts seem 40 years older than the rest of my 28-year-old body. I'd had nice-but-small B cups, until two babies and breastfeeding took their toll. They're now even smaller, less-than-firm A cups. And no matter how hard I tried to convince myself, the perception of the ideal breast has always been firm and upward tilting - no matter what size - rather than flabby, elongated or tubular.

After the unavoidable examination, we get to the business of deciding what to do about them. I'm diagnosed with hypomastia with marked ptosis - medical jargon for breasts that are small and too saggy. A more accurate diagnosis would be hyper-sensitivity - since there's nothing wrong with having small or saggy breasts. I just happen to hate them.

Although what I'm asking for may sound simple - I want an increase to a generous B cup - the logistics are complicated. Implants come filled with saline (sterile saltwater) or silicone-gel (a rubbery plastic gel), they're either round or tear-drop shaped and smooth or rough surfaced. Then there's your body to consider, like the size of your natural breasts, where your nipples are, how elastic your skin is, how much fat there is on your chest, how deep your chest wall is and how muscular you are.

After much debate, we select round saline implants, size 210cc, which will take me from a 34A to a 36B. My surgeon tells me that the most popular size of breast enlargement in Hong Kong is 180cc to 210cc - roughly one cup size - compared with 300cc to 350cc in the US.

Saline implants are safer than silicone (which are still not approved by the US Federal Drug Administration) if they rupture, but saline implants don't feel as realistic and they can wrinkle or ripple. I'm told that many younger, single women want silicone implants because they feel more natural.

Day one: The two-hour operation under general anaesthesia gets under way. The surgeon makes a 3cm incision under my armpit, slides the implants underneath my pectoral chest muscle, directly on top of my rib cage, and then stitches me up again, leaving two drains from either breast to allow fluids to drain away in a collecting pot attached to my dressing gown. Putting the implant beneath the muscle, as opposed to beneath your breast tissue, is more painful and the recovery is longer, but the implants will be harder to detect. Many surgeons make the incision under the breast, just above the crease or around the areola, but this can lead to more obvious scarring.

The pain when I wake up is unbelievable. The leaflets talk of 'discomfort', but this is surely a mistake. It hurts to breathe, talk and, thank goodness, I don't need to sneeze as that would be excruciating. In spite of the pain, I can't feel my breasts, as they will be numb for a few weeks, maybe months, until the tissues heal. Sometimes the loss of sensation is permanent.

Day two: Much the same, except that the mental drowsiness had worn off, so the pain is more acute. I still need help going to the toilet, because it's too painful to manoeuvre myself. My breasts are still wrapped beneath an elastic bandage so I haven't seen them.

Day three: The surgeon saunters into the hospital room to reveal his masterpiece. The bandages are unravelled, the dressings changed and I'm helped into a large sports bra. As soon as I'm alone, I burst into tears. My breasts look enormous, like a porn star's. One is bigger than the other and I can feel a hard lump beneath one of my breasts.

I go home and spend much of the day (and night) in tears, veering between wanting them removed to having smaller ones put in. My surgeon reassures me that, initially, most women feel the same - many will eventually wish they'd gone for bigger implants - and that I need to wait several weeks for the swelling to subside.

One could potentially return to work by day three - if your job allows you to fall asleep at your desk. It's still painful and hard to move my arms, and ideally, I should rest as much as possible.

Day five: I'm beginning to like them - much of the swelling has disappeared, leaving two amazing-looking breasts. I feel gorgeous.

I see my surgeon, who teaches me how to massage the implants to help prevent capsular contracture. This serious complication is caused by tightening and squeezing of the scar tissue that naturally forms around the implants. It can lead to pain and distortion of the implant and breast, sometimes requiring implant removal and can happen anytime within weeks to years. My surgeon gives me three months of medication as a preventative measure - not a treatment. He tells me that the risk of capsular contracture is higher for Asian women, since their skin scars more, and that about 20 per cent will suffer from capsular contracture, to varying degrees.

Other risks associated with implants include rupture, infection, movement, creasing or rippling of the breast around the implant, loss of sensation and possible complications with breastfeeding.

They can interfere with mammograms, making breast-cancer detection harder, but implants placed below the muscle allow more accurate readings as 90 per cent of the breast tissue is still visible, compared with 75 per cent of visible breast tissue if the implants are placed above the muscle.

Day seven: By now, I'm thrilled with my breasts and going about my normal life, albeit slower and more carefully. They still feel tender, especially around the borders of the implant. I have the stitches removed and the surgeon massages the implants quite vigorously to help prevent capsular contracture. Some sensation is now returning. I celebrate with a shopping trip. But, I'm still uncomfortable with wearing revealing tops. I had surgery to restore my contour and ease the lack of confidence in my breasts. I didn't do it to attract attention.

Day 14: I see the surgeon for another check-up. He reminds me that, although some women retain their implants for life, most will need theirs changed sooner if they experience complications. The scars under my armpits are healing extremely well, and my transformation now looks completely natural.

He says that in another two weeks I'll be able to start exercising again and most of the sensation should have returned. My breasts will continue to change shape over the next few months until they settle into their permanent position.

For a hefty HK$70,000, I can honestly say I've got my money's worth. Would I recommend it? I'm glad I did it, but I'd suggest shopping around for a reputable surgeon before taking the plunge.