People magazine’s June 1, 2015 “Body Issue” featured the 108 most talked about bodies. “Bikinis at every age” features desirable images of women, many of whose proportions are greatly admired and requested in my practice. The post­modern female (2000 onwards) attributes reflect a sociological change away from the 80′s masculinized “glamour” models or 90′s “heroin waifs”. High priorities are a) toned arms; b) slender torso (WHR 0.7 has been constantly favored in “centrefolds” since the 1950s; c) firm, shapely buttocks, which contrast with a narrow waist; d) non­porno breasts. Many of my patients are physically fit (run, Cross Fit, yoga, pilates) and sculpt their torsos but are unable to achieve their desired breast by dint of exercise. Prior to arriving in my office, today’s cosmetic patient does his/her homework, has multiple consults and is likely to be an active participant in their health decision making. In lieu of aspiring to reproduce any celebrities’ features, my clients are emphatic on what they don’t want: 1) Tori Spelling’s “Grand canyon” cleavage; 2) Tara Reid’s droop; 3) Christina Hendricks chest, etc. I’m impressed that many are fully cognizant that age will intervene, future procedures may be needed and they are savvy consumers, actively choosing beautiful “B” cups, which can be augmented with lingerie but still be compatible with their active lifestyles. Since 2011, I have explanted 150 patients; recurrent themes include 1) intolerance of the musculoskeletal load on back, shoulders, neck; 2) unforeseen breast volume growth and subsequent droop; 3) body self image distortion (feel fat, nonauthentic, etc.); 4) bona fide complications such as capsular contracture and deflation; 5) wishing to opt out of the maintenance. Retrospectively, controlling for patient body mass index, the implant volumes produced C+ to DD cup sizes. For the past decade, implant exchange for purposes of volume increase has been rare in my practice. I believe this is due to a cultural shift in values. We are no longer opting to “super size” our french fries or our breast implants.

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