Who Should (and Shouldn’t) Get a Breast Augmentation

When Dictators Decide What’s “Acceptable”

And I thought that the Supreme Leader would stop at haircuts.
But no — Kim Jong Un is banning breast augmentation, deeming them anti-socialist.
I think this is a bad day in Pyongyang.

History will tell you that when governmental leaders have the chance, they impose rules to make their citizens comply with their wishes.

Iranian rulers do not wear neckties, as this is seen as a Western custom.
Fidel Castro banned golf as it was a capitalist pastime.
The list goes on.

So, assuming that you don’t live in North Korea — who should get a breast augmentation?

What Is Breast Augmentation?

Breast augmentation is an aesthetic procedure designed to enhance the physical form of the breast. The goal is to help a patient’s body better align with their body image and sense of self.

Though silicone or saline implants are the most common devices used in breast augmentation, enhancement can also be performed using fat transfer.

The most important factor in performing breast augmentation is determining the patient’s desires. Many methods can help communicate what that ideal outcome looks like:

• Photos of other people can help express a patient’s wishes.
  
• Bags of rice worn inside a bra can help estimate added volume.
  
• Breast implants placed in clothing can show the desired look. 

All of these methods require some adjustment by the plastic surgeon to choose the best implant or volume.

You can rely on a surgeon’s judgment or published sizing guides — but that means the choice is someone else’s, not the patient’s.

My preference is to use breast sizers, which can accurately show what a specific volume will look like. I also use a 3D photographic simulator (Vectra), which gives an excellent representation of the desired result. The process is both revealing and transparent.

Potential Risks and Complications

All surgeries come with potential risks. Here are some of the most common considerations:

Capsular Contracture (CC)

The most frequent complication is capsular contracture, a hardening or distortion of the breast.
The degree can vary — from very mild to disfiguring and painful.

Treatment exists, but it can require further surgery. The best approach is prevention, as most CC cases stem from bacterial contamination during surgery.

Sensation Changes

Breast sensation depends on nerves. If nerves are stretched too much, temporary loss of feeling can occur.
The good news: most patients regain sensation over time.

Implant Rupture

Implants can break, causing changes in shape and volume.

• Saline implants deflate noticeably.
  
• Silicone implants may require imaging to detect rupture. 

Broken implants should be replaced, though this isn’t an emergency.

Illness Concerns

Illness directly caused by breast implants has not been scientifically proven.
However, anecdotal reports and rare tumor cases — linked mainly to textured implants — warrant discussion with your surgeon.
Details matter, and every patient deserves a sincere, informed conversation.

Fat Transfer: A Natural Option with Limits

For patients who prefer not to have implants, fat transfer offers a more natural alternative.
The challenge? Not all fat survives the transfer, even under ideal conditions.

Fat transfer is best for those seeking modest enhancement without foreign materials, but results can’t promise a specific size or shape.

So, Who Should Get a Breast Augmentation?

Someone who:

• Genuinely wants one. 
• Is healthy and realistic about expectations. 
• Understands that complications can occur. 

Many doctors can give you a good breast augmentation on a good day —
but it takes a great plastic surgeon to guide you through the bad days.

And Who Shouldn’t?

Anyone who wants to stay out of trouble in North Korea.

Sigh.