So you’re at the bar/wedding reception/gym/dog park. And for the hundredth time, the Antonia Banderas look-alike heads right past your sparkling repartee and straight into the vortex of your friend Dana and her double Ds. He’s hanging on her every word, staring at her breasts like the lips of a translator. You stand by, cocktail/towel/leash in hand, ashamed of yourself and your A cups. In the mating scene, they have failed you once again. A boob job is beginning to sound better all the time.

Most would argue that going under the knife just to attract some dude looking for a big rack is pretty retro, and it is. But becoming more attractive to the opposite sex is just icing on the cake for many women who opt for breast surgery. Take the typical mom, former heavy girl or older woman, who once had full, firm breasts until breast feeding, losing 50 pounds or gravity came along. Some women turn to augmentation after a mastectomy, to get their body back to how it was before cancer. The rest? We just want to see how the other half lives – the half who look good in a halter. Whatever the reason, breast augmentation is the second most popular cosmetic surgery in the U.S., after liposuction.

It’s tempting to think of breast surgery as a quick fix. However, implants were, back in the days of leakage and lawsuits, and always will be, serious operations. This is not the time to flip through the Yellow Pages. To avoid ending up with carpet inside your chest (true story) instead of FDA-regulated saline or silicone, research credentialed surgeons online at sites like the American Society for Aesthetic Plastic Surgeons and get the further skinny on complications at message boards like makemeheal.com.

There will be a lot to discuss at your first consultation. There is size: B, C or even D? (Though you can ask for the Dolly Parton special, a good doctor will advise against taking on more than your body can handle. Oversize implants look fake and cause backaches.) Will you get silicone or saline, round or teardrop shape, placed above or below the chest muscle? Will the incision be made around the areola, armpit, belly button or breast?

Both silicone and saline have an outer shell of silicone; the difference is saline breast implants are filled with a sterilized salt water solution instead of silicone. Each has its advantages and disadvantages. Saline implants, for instance, don’t rupture and leak as often as silicone implants do. If a saline implant does leak, you’ll know right away because the breast visibly deflates. Another plus is that you can opt for an adjustable rather than fixed saline implant, which lets you add volume later if you need a pick-me-up.

Silicone implants are generally thought to feel more like natural breasts than saline implants. However, leakage occurs about 10 percent of the time, usually within six months of surgery. Oozing silicone gel typically hardens the breast and can cause a lot of pain. It was never proven that implant leaks cause other health problems, but they do require treatment and occasionally complete removal of the implant. Today, the most common complication is capsular contracture, a hardening of scar tissue around the implant that can also require a do-over in serious cases.

Finally, this surgery isn’t cheap. The implants themselves cost about $3600 for saline $4,000 for silicone. Add the thousands of dollars more that the doctor, anesthesia and hospitalization typically cost and you’re looking at an expensive outing, all on your dime unless you’re an insured mastectomy patient.

Like many other types of cosmetic surgeries, where you have your breast augmentation done is typically determined by the doctor, so if you prefer being in a hospital instead of an ambulatory facility or other secondary site, choose your surgeon accordingly. The operation takes between two and four hours, depending on where the implants are positioned. Below the pectoralis muscle is the most common practice; however, it is more painful and requires more recovery time. Over the muscle gives you the option of having local instead of general anesthesia. Unfortunately, this technique increases the risk of capsular contracture and interference with future mammograms. Plus, it just doesn’t look as good, especially on small-breasted women.

Before finishing, the surgical team will gently haul you into a sitting position on the operating table to assess symmetry. If all looks good you’ll be wheeled into post-op where your new breasts will be wrapped in surgical material or a support bra. After a few hours of recovery, most patients go home the same day.

• A ride home from the hospital and someone to stay with you for the first two or three days.
• Pre-filled painkiller and antibiotic prescriptions
• Ice packs to reduce swelling
• Prepared meals for the first couple of weeks
• Phone numbers handy to the hospital, your surgeon or friends/family.
• Entertainment – movies, books and other activities – that does not involve lifting your arms.
• A new wardrobe. Many of your bras and tops will no longer fit.

It will take a day or two of rest and possibly one night of sleeping upright before you’ll feel like getting up and moving. If you decide to sneak a peek at your newbies, don’t be alarmed at the discoloration and swelling. Stitches don’t come out until a week post-surgery, and it can take up to a month or two for swelling to completely subside. Finally, some implants take a year to settle into their permanent position, so it could be a long while before you know exactly what your ladies really look like. Just keep in mind that your body has gone through a major change and has to readjust.

In the first days get lots of rest and drink plenty of fluids. Avoid vigorous arm activity and sleeping on your stomach for two weeks. Sex after a week or so is okay but no rough play. Jogging is out for some time; in general, treat your new breasts with gentle loving care for at least a month until your body is officially back to good.

Expect possible emotional side effects. You might actually miss what your body used to look like or be surprised at the level of attention your new breasts do – or do not - get you. Prepare yourself for all scenarios, as you will have undergone a big physical change.

Did you know you can buy silicone implants to wear over instead of under your skin? Silicone breast forms placed in the bra look and feel very natural. Victoria’s Secret’s excellent water bras also look real and have a cozy lining. Add the silicone forms to the inside of your water bra cup and va-va-voom! No surgery, no scars, no problem taking an aerobics class. Just shed your big boobs before any occasion in which they would get in the way and you’ll have the best of both worlds.

--Cynthia Rice