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WebMD archives content after 2 years to ensure our readers can easily find the most timely content. See the latest news and features on Healthy Beauty. By her 18th birthday, Laura Kearney realized "the girls" weren't growing -- but she pushed aside thoughts of breast implants.

For eight years, she resisted the pressures of society -- images of stars and starlets, the focus on female anatomy. In the end, Kearney finally did do it -- tossed the padded bras forever, opting for silicone breast implants. I didn't want it to be, 'Look what she did. The ? In fact, she adds, the preparation for breast implant surgery pushed her into a healthier lifestyle. It was a big opportunity for me to be a healthier person. It felt like everything was going in the right direction.

It was so exciting. Breast augmentation -- breast implant surgery -- is the top cosmetic surgery performed today, according to the American Society of Plastic Surgeons. A total ofwomen had the surgery in It's a major step for most women, and often a positive one.

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Studies have shown that breast implants can help boost self-esteem, body imageand sexual satisfaction. But studies have also pointed to the critical need for careful screening by doctors, and self-awareness among women, before breast implant surgery. Women who may have psychiatric or alcohol problems before their surgery may be at higher risk of suicide years later. Here are realistic insights from doctors and patients about the impact of cosmetic breast implants, and how to tell in advance whether implants may help you.

Laurie Casas, MD, associate professor of surgery at Northwestern University's Feinberg School of Medicine in Chicago, is a contributing author of a textbook on breast surgery. Nearly half her patients are like Kearney -- young women whose breasts never developed, a condition called micromastia. She also sees young women who have developed asymmetrical breasts -- they don't match in some way, either in size or shape.

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It's a relatively common, embarrassing condition. One breast might be a D-cup, while the other is a B. Or there might be a half-cup difference between the breasts -- which might not sound like much, but can be very noticeable. It's a body image issue, not a self-esteem issue. They want that body part to look more normal, Girls with fake tits read this look better in clothes and bathing suits. All that rings true with Kearney, she says. I can go clothes shopping, and it's amazing how things fit. Here's another of Casa's patients: year-old Kristen Chase, who was "a generous 36B" before she had four children in seven years, she says.

My body bounced right back after the pregnancies, but my breasts didn't. I wanted my body back. Women like Chase grew up with a completely different mind-set, says Casas. These women went through their formative years feeling good about themselves. They work out, feel great. They just want the breast to be the nice normal size they had before.

The first time Chase looked into breast implant surgery, silicone implants weren't FDA approved. With her broad chest, a saline implant just wasn't appropriate. Her result with silicone? Another key point: "I've had zero sensitivity loss in my breasts. Nothing lasts forever. So you must expect at least one second breast implant surgery in your lifetime, and perhaps several. Breast implants that looked good at age 22 may no longer look good on the same woman after they have had children, breastfed, or grown older.

Postpartum women -- finished with pregnancies -- won't have so many breast changes, especially if they have kept their weight under control, says Casas. She's seen a handful of year-olds and talks them into waiting awhile -- to see if this is what they really want. They're the ones who have to take care of the implants, continue with follow-up. We will only move forward if they can make that commitment. Most women who get breast implants are realistic about the surgery, says David K.

He has authored a textbook chapter on the subject. For them, it's a body image issue, he says. They have realistic expectations that if this is done, they will look more satisfying to their own eye and to others. But their self-esteem does not depend on it. However, the journey to the operating table can be emotionally painful for some. One study showed that in the year before their breast implant surgery, women reported greater distress about their appearance and more teasing about it. They also spent more time in a psychiatrist's office than women who didn't get the surgery.

Over the years, Rod J. Rohrich, MD, chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas, has come to recognize the patient with unrealistic expectations. He won't treat patients who are going through major life changes -- divorce, death in the family, he tells WebMD. But it can make you feel better about who you are. When self-esteem and sense of self are more fragile, that's when people tend to have unrealistic expectations of breast implant surgery, explains Wellisch. The gap between their ideal self and real self -- or the way they see themselves -- is greater than for the other group.

For these women, breast implant surgery is a band-aid approach to a bigger problem, he says. I've seen it in my practice. But the surgery cannot transform a fragile or extremely vulnerable sense of self. It's no surprise to Wellisch that studies show an increased risk of suicide among some women with implants, often 20 years later.

Some women may hope that breast implants are a quick fix for mental health problems. But a decade later, the satisfaction fades for some reason, Lipworth says. We don't know for sure. Bottom line: Women need to be aware of this risk, she says. She should be aware that depression can return. Good surgeons will help women assess whether their expectations and reasons for wanting breast implant surgery are realistic. Rohrich turns away patients who make unrealistic requests -- recognizing it as a that they may have emotional problems. Maybe that's what some want -- and they can always get what they want somewhere else.

But I turn them away. Casas is also careful to screen for poor self-esteem Girls with fake tits read this body image. What do you see? They have to be able to see the real person, not who they think they are.

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If there are s of body dysmorphic disorderthey need a true psychiatric evaluation and psychiatric support. Healthy Beauty Feature Stories. Reality Breast augmentation -- breast implant surgery -- is the top cosmetic surgery performed today, according to the American Society of Plastic Surgeons.

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Continued She also sees young women who have developed asymmetrical breasts -- they don't match in some way, either in size or shape. Health insurance does not cover the surgery. Insurance also does not cover any follow-up surgeries. Yet complications do occur, and revision surgeries are sometimes necessary to correct a problem.

Also, both saline and silicone implants usually have to be replaced at some point because of breakage. Continued Over the years, Rod J. Continued Good surgeons will help women assess whether their expectations and reasons for wanting breast implant surgery are realistic.

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