Thinking long term is not a strong suit of the young

Among the controversies surrounding breast implants, and there are many, is the claim that many patients are not fully informed about the risks and limitations of the surgery, both immediate and long term. It is true that some surgeons gloss over risks or underplay them but I, and many, if not most, of colleagues try to properly inform patients regarding the good and the bad of the surgery. One problem is that many young women do not seem to want, or be able, to really think long term when it comes to breast implants.

My typical cosmetic breast augmentation patient is a young girl anywhere from 19 to late twenties, but the range is from 18 (I won’t do anyone younger, and really don’t like doing augmentations in patients this young except under unusual circumstances) to 60’s. The older the patient, the more comfortable I am, up to a point. I like the maturity of older women, the different perspective that life, having babies, being married, being in the working world, etc. brings them. I am more confident that they will listen to me and really consider what I tell them about implants. I worry less they will approach the operation with rose-colored glasses.

I start every consult the same way. I say something along these lines, “If you forget everything else I say, remember this. Breast augmentation takes your natural breast, that you are dissatisfied with, and does something to it that is both unnatural and irrevocable. It cannot be totally undone. It sets you on a path that is unpredictable. No one can say for any individual exactly what time and circumstances will do to them, their breasts, or their implants.”

Young women seeking breast implants face decades with a man-made medical device in a very important, sensitive part of their body which not only changes for all sorts of reasons over time but is also the site of the most common solid cancer in women. The lifetime risk for breast cancer in any woman is a scary 8-10%. Breasts will change, with weight gain or loss, from pregnancy and breast feeding, from the long term effects of aging and the pull of gravity. Breasts with implants are subject to all sorts of unique changes; some occur so gradually that big changes over time may go unnoticed. Implant pockets can contract or, conversely, stretch over time. Implants can shift too far every which way. There is no way to predict which women will experience particular changes.

I have had older women come to my office who basically have hard rocks on their chest and seem surprised when I tell them their breasts are too firm. Some are now second guessing their decision of decades earlier to get implants and a few tell me they were never informed that they might experience problems later in life.  

I try to prepare patients as well as I can. I really do. I tell them all of the above and more. I tell them implants are not expected to last a lifetime and that they almost certainly face at least one more operation someday, at their cost, to deal with issues directly related to having implants. Easily more than half of my consult time is spent on the risks and complications of implants.

With many young patients, I cannot help but wonder if they really hear me or pay attention. Many to come to my office with their minds already made up. A few even have their date for surgery scheduled before they ever see me. I really cannot recall an instance where I talked a young patient out of a breast augmentation. Often, I see my consult going something like this:

Me: “If you get breast implants now, you will have bigger breasts but you will be subject to all the risks of implants for as long as you have implants. ”

The patient hears: “Blah, blah, blah, implants, blah, blah….bigger breasts, blah, blah…..implants…….”

I even have an 8 page, single-spaced, typed summary of my consult that I give patients to review but I wonder if even this makes them think long term.

Many things make me believe that a lot of young women really do not think long term. Tattoos are one. I see more and more attractive young women that are tatted to beat the band. Did they consider that those brilliantly colored, sharp tattoos on taut skin will someday be faded, blurred blotches on wrinkled skin? Do they consider how it might limit them professionally someday?

Another area where I wonder how much consideration is given to the long term is the Brazilian Butt Lift. A disturbing number of young women are allowing their buttocks to be injected with sometimes astounding amounts of their own fat, sucked from some other place. They seek the Kardashian, Minaj, JLo bubble butt derriere seemingly without a thought of what time and gravity will do to that to those massive man-made mounds. Looking good today, whatever current fashion seems to dictate that to be, seems more important than taking the long view and considering consequences.

I, like most plastic surgeons, feel that breast implant surgery is a legitimate surgical option for women seeking more breast fullness, to correct other problems, e.g. assymetry, or to reconstruct a breast. So long as patients are properly informed and understand the downside as well as the upside of surgery, there is no reason not to offer this procedure. A number of women with implant problems claim they were never properly informed.

That’s one of the fallacies of “informed consent”. We can talk all we want to patients but we really never know how much of what we are saying they hear, understand, or take into consideration in their deliberations. We don’t know what they will recall of this discussion decades later. No one thinks the bad things will ever happen to them….until they do. All they see is a goal- full, beautiful breasts- and fail to see all the pitfalls and obstacles to obtaining that with our imperfect technology, techniques, and devices. They don’t look down the road a decade or two, or three, and try to imagine what they might have to deal with as a result of having implants now. When it comes to breast implants, living in the present is something the young seem to be very good at. Thinking decades down the road, not so much.