Pepper Body Blog Breast Augmentation Q&A with Dr. Catherine Hannan

Have you ever considered breast augmentation surgery? 30% of small-chested women in our Body Confidence Breakdown survey responded they have. At Pepper we hope to create a world where women celebrate their bodies as they are, but fully support however it is you feel the most confident. We believe every body is a good body, with plastic surgery or without. You’ll always be beautiful to us! We invited a board certified plastic surgeon to join us via Instagram Live on October 23rd 10:30am PT / 1:30am ET to answer all your Q’s around the pros and cons of breast augmentation procedures, and to get her perspective on modern day body standards. Make sure you’re following us on Instagram @wearpepper and mark your calendars to tune in! Here’s an introduction to Dr. Catherine M. Hannan: Catherine M. Hannan, MD is a board certified plastic surgeon in Washington D.C whose practice is majority female and breast surgery including reductions, enlargements, and reconstruction. She earned her undergraduate degree from Yale University and completed her medical degree at Georgetown University School of Medicine, where she is now is also an assistant professor who mentors aspiring young female surgeons. ~aka Dr. Hannan is a badass~ What are reasons you’ve heard women undergo breast augmentation? According to the American Society of Plastic Surgeons, breast augmentation has been the top cosmetic surgical procedure in the US for over a decade.  In 2018 alone, 313,000 breast augmentation procedures were performed.[1] In most circumstances, breast augmentation can be a wonderful procedure that boosts a woman’s self-confidence, especially in women who experience sagging and deflation after pregnancy and breastfeeding, weight loss or even just with aging.   In addition to our skin thinning and stretching over time, the connective tissue bands under the skin called Cooper’s ligaments, which help suspend the breast tissue on the chest, also stretch and loosen. Many women therefore choose breast augmentation, sometimes combined with a breast lift, to restore their breasts to the fullness they had before these life changes. This can truly make some women more feminine.  Similarly, younger women who feel they have little to no breast tissue often seek breast implants to feel more proportionate to the curves of the rest of their body. There are additionally unique body situations where implants may be necessary to restore symmetry or a better shape. Some women are born with one breast significantly larger than the other.  This can make fitting into a standard bra almost impossible. In this situation we would either augment the smaller side or reduce the larger one, depending on their tissue and their preferences.  Another unique breast shape that we often address with breast implants is a tuberous breast deformity. These breasts fail to develop normally during puberty, resulting in very wide set breasts with narrow bases, significantly large areolae and little breast tissue.  Lastly, we frequently perform breast augmentation in transwomen who are transitioning.  Are there possible negative complications? As with any intervention in medicine, there are certainly negatives that we must explain thoroughly with our patients.  All surgeries carry the risk of infection and bleeding as well as pain and scarring. The plastic surgery literature states that around 20% of women will have a second surgery in the 6-10 years after their first breast augmentation. [2]  Fortunately, many of these patients choose to have larger implants placed. However this statistic also includes patients who have complications like infection leading to loss of the implants, misplacement of the implants or capsular contracture which is a hardening of the scar tissue around the implant.  Additionally, breast implants are unfortunately not permanent devices. The average lifespan of a breast implant is 10-15 years, after which we expect that there may be a rupture in the shell. If the implant is filled with saline, or salt water, most women will know that it ruptured as the salt water will leak out, be absorbed by the body, and the breast will shrink in size.  If the implant is silicone, the patient may have no idea that the shell has ruptured. Newer generations of implants are cohesive, meaning even if the shell ruptures the silicone stays in place (similar to cutting a gummy bear in two). However, most older silicone implants will leak soft liquid silicone into the capsule of scar tissue around the implant. Because there is no good way to detect a rupture by feeling alone, the manufacturers of silicone implants recommend a screening MRI 3 years after they are placed and every 2 years after that to look for rupture.  Unfortunately, because these implants are usually placed for cosmetic reasons, most insurance companies will not cover the cost of these screening mammograms and therefore patients do not usually obtain them. There is growing concern by patients who have breast implants about a variety of symptoms that they have experienced and believe to be directly linked to their implants including, (but not limited to) fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, anxiety, brain fog, sleep disturbance, depression, neurologic and hormone issues collectively called Breast Implant Illness (BII).  We unfortunately lack evidence of a direct link between silicone breast implants and any known disease. However, many patients with these complaints do report various degrees of improvement after removal of their implants and their surrounding scar tissue. Far more research is necessary to help clarify any connection between these symptoms and implants. What are your thoughts on the bra industry? I perform both breast augmentations and breast reductions every week in my practice.  One of the most common complaints that I hear from both types of patients is that they cannot find a bra that fits well.  Very large breasted women often state that they wear two sports bras for support yet still have neck and back pain and grooves in their shoulders from the bra straps.  The smaller chested women complain that they cannot fully fill a standard store-bought bra without gaps. I personally have identified with the latter group, especially after two pregnancies and nursing.  It can be so incredibly frustrating to spend hours shopping and fitting as well as hundreds of dollars over time to not find a product that is truly ideal for one’s body shape and unique breasts. While the bra industry has certainly come a long way from the torpedo shapes of the 1950s, there still remains considerable room for improvement.  One thing I’ve found disappointing in particular is the placement of the cups. Each woman’s breast has a unique footprint on the oval shape that is the chest wall- some breasts are set very far apart, or laterally based. Therefore, not every woman’s breasts sit facing forward like headlights. So to make most bras that have cups facing forward just ignores a good deal of the population.  It also assumes that all women want enhanced cleavage when many of us just want minimal support that emphasizes coverage and comfort. Personally, during a long day in the operating room or in the office seeing patients, I want a bra that is comfortable to the point that I never think about it.  Got a question for Dr. Hannan? Drop it in the comments below and we’ll ask her in the IG Live on October 23 10:30am PT / 1:30pm ET!  ------ [1] https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf [2] https://www.researchgate.net/publication/328684113_Reoperation_Rate_After_Primary_Augmentation_With_Smooth_Textured_High_Fill_Cohesive_Round_Breast_Implants_RANBI-I_Study