Breast implants for cosmetic augmentation first became available in the 1960s and rapidly gained popularity in the 1970s. By the 1980s breast augmentation was the second most popular plastic surgery (after liposuction), and the motto seemed to be the bigger the better. The oversized implants seen everywhere in the popular media in the 80s and 90s clearly served to alter the publics perception of what breasts are supposed to look like: large, taut and high. The kind of breasts that formerly appeared only in cartoons.

Today, breast augmentation is more popular than ever. According to the American Society of Plastic Surgeons (www.plasticsurgery.org), 254,140 breast augmentation surgeries were performed in 2003. This is a 7 percent increase from 2002 and a 20 percent increase from 2000. But reason is beginning to prevail again, and patients and the public are rediscovering the fact that the aesthetic ideal for the female breast is soft, supple, much fuller in the lower than the upper pole, and in proportion to the rest of a womans figure.

Patient demographics are changing, too. Women in their 30s and 40s (especially moms) are the fastest growing group of patients seeking breast augmentation today. These are women who have lost breast volume following pregnancy and lactation, and who simply seek to restore a natural, more youthful breast contour. They dont want to look like theyve had surgery; they instead wish to fill out clothing better and feel more comfortable out of clothing. Even women who have not had children are opting for smaller, more realistic appearing breast augmentation. Professional women (including physicians!) want to look their best, but they dont want to look done.

It is very common in my practice to perform an enhancement that changes the breast profile from and A cup to a B cup, says Dr. Michael Law, a board-certified plastic surgeon in Raleigh, NC, formerly of Beverly Hills. I rarely have patients requesting large implants anymore, although there are still a few who express a desire for that busty, done look. I counsel those patients that it is certainly possible to achieve that look, if it is truly what they want, but that I simply wont perform any aesthetic surgery that doesnt look natural. A woman with very large breast implants that doesnt match her frame looks like a cartoon character, and that is not my aesthetic ideal. And these patients never have any problem finding someone who will give them the look that they want.

Potential breast augmentation patients should also give serious thought to the following consideration: one great advantage of a conservative breast enhancement is that small implants are much more likely to feel natural. It is possible to provide an enhancement that is soft, supple and even undetectable (by touching) with a small implant, something that is never achieved with very large breast implants.

One of my most recent breast enhancement patients (another doctor) had the following to say at her three-week follow-up appointment: If I hadnt written a check to pay for them, Dr. Law, I wouldnt know theyre not really mine.