New Year, Brand-New Breasts?(breast implants and questions to ask surgeon)

Renae Waestman, 27, had always wanted the perfect hourglass figure: she thought her small breasts didn't go well with her slender waist and ample hips. It's not that she wanted the bust of Pamela Anderson--Catherine Zeta- Jones's would do just fine. So, two years ago, Waestman went to a top plastic surgeon. Today, owing to two saltwater-filled sacs, she's the proud owner of a C-cup chest, up nearly two sizes from what nature gave her. "It's one of the best things I've ever done," says Waestman, a project manager for a southern California design firm.

A decade ago breast implants seemed to be on the way out. The old kind-- filled with silicone gel--were linked with debilitating health problems, so- called connective-tissue disorders, such as lupus and rheumatoid arthritis. They became the subject of class-action lawsuits, and in 1992, the U.S. Food and Drug Administration banned their cosmetic use. For a year or so, the number of augmentations plummeted.

Not for long. Thanks to saline implants and the eternal appeal of a bigger bust, more women than ever are choosing surgical enhancement. Since the early '90s, breast augmentations have increased fivefold in the United States--to more than 206,000 in 2001, and doctors say the numbers continue to increase. (An additional 81,000 U.S. women had breast reconstruction, typically after mastectomies.) Not only is the number of procedures growing dramatically, the average size of implants has increased 40 percent since the 1980s. One of the two U.S. manufacturers is seeking FDA approval of new silicone models, which tend to have a more natural look and feel. Some plastic surgeons are betting they'll be back later this year.

No one should mistake the fact that implant surgery is a real operation. It's done under general anesthesia, leaves one- to two-inch scars and carries the possibility of complications ranging from infection to ongoing pain. Some patients return to the OR to change the size or shape (there are dozens of variations to choose from), repair defects, or remove the devices altogether. Moreover, no implant is permanent--like a heart pacemaker, it requires replacement, often within 15 years. Implants also make diagnostic mammography more complicated, may ...