Something that I grapple with continually is the question of what we mean by "good outcomes".
That is an appropriately nebulous sort of question, so I'll provide a little context.
I was attending a conference recently (admittedly, I was in remote attendance, online, wearing tracksuit pants, but whatever) and I was watching a range of presentations on breast augmentation.
Some may find it odd that I am watching presentations on a procedure I don't do - however, as a surgeon who focuses on correcting prior surgery, including when doing explant, understanding what the rest of the world is doing with implants is vital because it helps guide some of my surgical decision making when I need to fix the mess that has been created.
Anyway, that aside, I was watching these presentations and I found myself asking the question I posed at the start. Some of the results presented were objectively reasonably good (at least insofar as they had acheived the objectives that the surgeons' set for themselves). And yet, I couldn't escape the fact that there was still something very obviously off about the results being presented.
Two presenters in particular piqued my interest. A chap from Brazil (who, in a most clichéd fashion, burst into tears when discussing his upcoming book publication...bless him), and a very well known surgeon from Sydney. Interestingly, both of these surgeons were focused on a similar idea - how to hold an implant UP as high as possible on the chest.
And I think that the most obvious reason for my discomfort is that in the case of both speakers, whilst their results could be classified as good based on a number of metrics, my brain saw them as otherwise for a very simple reason: they were both presenting outcomes that were distinctly, irrefutably, unnatural.
The image at the top of this article is from the Brazilian guy and represents an example of his work: the implant sure does sit high, and the breast sure is lifted, but that breast shape in side profile sure is unnatural.
And so then we have to think about whether an unnatural result can indeed be a good result...but that is where the discussion will tend to fall apart because of the subjective nature of the outcome we are trying to assess.
I think therefore that my issue can be best be summed up by the fact that I think natural is always better than unnatural. It is obvious in the work I choose to do and in the outcomes I try to achieve. It is fundamentally why I have largely abandoned the use of breast implants in a primary setting and only use them for revision work.
That is a personal, subjective decision that I have made based on my own considerations for aesthetics. And that should highlight two points: 1) you need to, in some fashion, have a similar aesthetic sensibility as your surgeon and 2) implants aren't inherently evil, I just don't think they look natural in most cases unless you are using very small devices.
Which takes me to one final rumination.
Small implants, which can possibly offer "natural" outcomes are very, very constrained in size - we are typically talking about "mini" projection devices of well under 200cc - are still worth considering for some ladies. And I think they can work very well.
But the ideas I saw presented at this conference which involve big implants around 350-400cc with substantial removal of natural tissue just strike me as being...rather short sighted.
That will neatly take me onto another topic I have been meaning to talk about and will write something on soon: namely, whether surgeons who put implants in should bear some responsibility for the eventual difficulty/outcome of explant procedures. There is a bit, I think, to unpack there.