To BE or not to BE
(Is Breast Enhancement Worth it?)
By Paige Norman

Just how big do breasts have to be?

No matter where you stand (in front of them or behind them), more and more often, the answer is simply bigger than they are.

More than 264,000 women had their breasts surgically enlarged in 2004, and the number increases every year. It's not hard to understand why. Despite the fact that size has absolutely nothing to do with function or sensitivity, and very large breasts can be, quite literally, a pain in the neck, shoulders, and back, society has made it clear that big breasts embody all that is good, feminine, and desirable. Women with small breasts often feel inadequate, unattractive, self-conscious, discounted, and ignored alongside their more conspicuous sisters.

Less often, women may suffer from deformities, extreme sagging, or lopsided development that can be corrected. Breasts can be restored after mastectomy for cancer treatment or newly created for transexuals.

Women who've had breast augmentation may feel more beautiful, sexy, or empowered. Self-confident. Elated. But sometimes they're not so happy.

Any surgery is risky. If you're considering breast enhancement, here are some things to consider.

There will be scars. They should fade over the first year; if the surgeon is good, they're minimal. But some enlarge or become permanent and may have to be removed surgically. Calcium deposits may form in the scar tissue, causing pain and hardness and sometimes interfering with mammography.

Capsular contracture is the most common problem. The scar (capsule) around the implant may tighten, squeezing it out of shape and hardening the breast. This requires more surgery and possibly removal of the implant.

Blood or serum can collect around the implant and cause capsular contracture or infection. This may need more surgery that can cost more than the original augmentation.

Occasionally, infection alone may require removal of the implant, though after the infection clears, a new implant may be inserted.

Implants can shift or be improperly placed, although the resulting asymmetry and discomfort can be corrected by more surgery. As many as 10 women in 100 have this problem (more than 26,000 last year).

The implant can deflate, leak, or rupture. It can even break through the skin, if the skin covering it is very thin. Surgery can remove the implant and repair the area, but it may cause tissue loss and scarring.

Drooping (ptosis), when the natural breast tissue sags but the implant stays put, causes a double bulge that makes a breast look like Snoopy in profile. More surgery is the only fix.

Nipples can lose sensitivity. This is fairly common and usually gets better after six months. But for about 20% of women, diminished sensitivity or numbness is permanent.

Skin may wrinkle and ripple if the implant pulls on overlying tissues. Sometimes the folds of the implant can be seen through the skin. This happens to as many as 21 women out of 100 (more than 55,000 last year).

Breast implants aren't permanent. Eventually they must be replaced or completely removed. About one quarter to nearly one third of all breast augmentations require re-operation within five years.

But possible complications aren't the only things to consider. Post-operative pain can be moderate to severe, and doctors often prescribe one or two weeks of painkillers. Swelling can last for months; you may not be able to see the final results of the surgery for at least four months.

Finally, the average total cost for the surgery is $7000. You may also need to figure lost earnings (due to time off from work) and paid help (if you need it) while you recuperate. Medical insurance won't pay for any of it, unless perhaps you're completely missing one breast or need reconstruction after mastectomy.

Of course, you can use credit cards or a bank loan to pay for cosmetic surgery. Finance companies offer another option. But with any of these sources, don't overlook the additional cost in interest fees.

So, how big do breasts have to be? Maybe a better question is, how much risk and expense are they worth?