There was a recent concept that hit the news circuit that involved a doctor doing what was described as a temporary breast augmentation- and I don’t think it’s fair to let this story go without comment. As a New York, Long Island and Westchester plastic surgeon specializing in breast augmentation, breast reduction and breast lift surgery I am very qualified t comment on this topic. Unfortunately, this is the type of story that gets great play in the New York media, whether or not it represents good medicine. This story has generated numerous phone calls to my practice so here are my thoughts.
The concept is that injecting something into the breast will obviously make it larger. If what was injected was a relatively innocuous substance, then the temporary gain comes with no downside other than it being temporary. In a sense what another New York Plastic Surgeon is doing is injecting saline (salt water) into the breast with the understanding that, in a short amount of time, the body would just reabsorb it. A temporary Breast Augmentation- I guess if we could safely change the body in the same way that make-up, temporary tattoos or Spanx change the appearance then perhaps there would be a valid place for it. It seems to me that the concept of a padded bra falls more into this category as it is a completely non-invasive ‘fix’. But does injecting saline- large amounts of saline- change the breast in the same ‘risk-free’ way make-up changes one’s complexion? I think not and I personally think it’s bad medicine.
The average size breast implant I use in my practice is about 300cc in size. I have no doubt that anyone interested in temporary breast augmentation is looking to make a statement, so is looking for at least this change if not more. Injected saline will immediately begin to be absorbed and will be nearly fully absorbed within about 12-48 hours depending on the amount injected-maybe even faster- so I guess if that short term a change would make someone happy then it’s worth the conversation. In other cases where injected substances or medications are carried in saline the volume change from the injection seems much shorter in duration than this. One good example is with Sculptra-a relatively new concept in facial volume enhancement similar to a facial filler. Sculptra is a powder that does not dissolve in water or saline. In order to inject Sculptra it needs to be mixed with some liquid to carry it as a suspension, so saline is typically used. The immediate effect seen in the face is from the amount of saline injected, not from the Sculptra itself. After 12-48 hours there is residual swelling and some bruising present, and patients may complain of some discomfort due to this swelling or bruising for several days. With Sculptra injection the intention is not to get bruising or swelling, but let’s be honest, multiple small needle sticks are involved and needle sticks cause swelling and bruising. Sculptra is injected through a very tiny needle to avoid bruising as much as possible. This is feasible because only about 9cc of Sculptra suspension is injected on each side at any one time.
The concept of injecting 300-1000cc of saline into each breast would require much larger and longer needles- or even the use of injection cannulae similar to what is used to inject local anesthetic before liposuction procedures. The breast, especially in younger patients, is very vascular. It’s not unusual for surgeons to inject the breast with local anesthetics prior to breast reduction surgery in an effort to reduce surgical bleeding. Any surgeon who routinely does this will tell you that bruising is seen within the breast at the time of surgery from these injections. Personally I do not believe that infection is an honest concern in these cases. In the short term my concern is bruising. In the long term I’m concerned about breast pain and non-specific discomfort.
There are cases where this procedure could be used in the patient who is considering breast augmentation to give a sense of the effect of inserting breast implants. Over the years many novel ways of simulating breast augmentation have been used including placing silicone inserts or rice-bags in the bra. Today 3-dimensional imaging systems such as the Vectra, a system I was instrumental in developing, are used to show a patient in a photorealistic way the effects of inserting implants of a variety of sizes. No rice-bags and, certainly, no injections required!
The true concern I have, when we weigh the risks and benefits of any procedure we perform as Plastic Surgeons, is whether or not this procedure meets the criteria of ‘good medical practice’. Realistically the changes from this procedure will affect the patient both in and out of clothing. In clothing a patient can simulate the effects of breast augmentation with a bra insert or maximizing bra. The issue more so is the ‘out of clothing’ effect and, in the short term that the effect is visible, the appearance of multiple needle-stick sites and bruising are definitely two big entries in the ‘negative’ column.
As a Plastic surgeon I am frequently asked to do things that are not medically indicated, but rather address a concern for the patient. Good medical sense says that as long as the benefits significantly outweigh the risks then it’s reasonable to do the procedure. The idea of a very temporary injectable breast augmentation just doesn’t pass this test for me. For these patients a trip to a nice lingerie store with this significant change in mind can prove to be a fun afternoon with the purchase of a safe, fashion-friendly and reusable solution! And for those eventually looking for an education, 3-dimensional simulation, or a permanent solution…call me.