Dear Dr. Roach: My fiancee wants to have her breasts lifted, as they are starting to sag. Also, she wants to get them augmented a cup larger. What are your thoughts on this subject? Also, what are the medical risks involved for either procedure?
A: I have had many patients ask my opinion about cosmetic surgery, and I have found it wise to confine my comments to the medical risks of the procedure and to refrain from offering an opinion on appearance. It's up to the person to decide whether he or she wants it.
Most women who undergo mastopexy (lifting procedure) or implantation (augmentation) are happy with their results and do not have complications. However, the risks of a complication are not zero -- any surgery can have complications. The immediate postoperative risk in an augmentation with implant is less than 1 percent for a local hematoma (blood collection), less than 0.5 percent for infection, and much less than 1 percent for a serious adverse event like a leg blood clot. In a recent study, the reported overall complication rate was 10 percent (pain and nipple numbness are among the most common), and the vast majority of women would repeat the surgery.
However, breast implants do not last forever, with the average being about 10 years. The implants can rupture, and the Food and Drug Administration estimates that 10 to 20 percent of women will need their implants removed or replaced within 10 years. Breast implants can interfere with breastfeeding, and they make screening for cancer more difficult.
The concern about breast implants and autoimmune disease is controversial, but most authorities find that the risk of developing an autoimmune disease is the same for women with breast implants as those without them. There is an increased risk for a rare cancer, anaplastic large cell lymphoma, but the risk is still low, about 3 cases per million per year. It is clear that more women are choosing to remove their implants over time, about 9 percent in one study. Part of this may be due to decreased satisfaction with aesthetic results: 86 percent of women felt the appearance was at least acceptable at two years after augmentation, but only 54 percent at the five-year mark. Over time, the appearance may ripple or become asymmetric; a capsule may form, making the appearance less natural.
You and your fiancee also should consider the financial costs of the procedure, including the possibility of reoperation years from now, which generally is not covered by insurance. The cosmetic results after reoperation are never as good. Many surgeons have representative pictures on their websites, but be sure to look at how the breast looks after removal of an implant.
Dear Dr. Roach: You recently wrote that there is no dietary change that could prevent postpartum depression. I have read that pregnant women who supplement with omega-3 have a considerably decreased risk of PPD.
-- C.C., M.D.
A: I had read that, too, but a study a few years ago randomized pregnant women to fish oil capsules (versus capsules with no omega-3), and found a trend toward decreased depression that did not meet statistical significance. A study a year later did show an improvement in depression scores, but a 2016 review by the Agency for Healthcare Research and Quality found no effect on risk for PPD. Based on this, I still feel that omega-3 fatty acids are not an effective way of preventing postpartum depression.