The Duchess of York (pictured) made news when she appeared in public in a low cut dress that revealed a sun damaged, aged cleavage.

The fault lies not in the 50-year-old’s stars but in the sun.

Being a redhead also means having the most sensitive skin known. But for any woman, why go to the trouble of having breast implants if the girls are covered in wrinkled, sun damaged skin?

What is a girl to do? Wear a turtle neck every day?

More plastic surgeons are stepping forward to provide treatments for the aged, sun spot splotched décolletage. It appears to be more of a problem as a woman approaches age 40.

Actually, there are some habits, beyond lying out under the sun, that contribute to cleavage wrinkling. For one, the skin in the cleavage and lower neck is very thin so it damages easily.

First, the no-no’s for keeping smooth skin just below the neckline:

• Tanning booths count as sun damage. Stay away!
• When you put sun block on your face, apply some to the cleavage
• Sleeping on your side wrinkles the cleavage. Special pillows and neck rests can help.

Some plastic surgeons who are good with injectables are using the newly approved Sculptra to plump up cleavage skin and drive the wrinkles away over time. Botox will also work, according to some practitioners.

 While most Retin A is applied to facial skin, the substance – which must be prescribed by a plastic or dermatologic surgeon – can also help aging and sun damaged skin on the lower neck and cleavage.

Ditto microdermabrasion. While that is another procedure that is often used on facial skin, it can also work nicely on the décolletage. However, lasers are intended to work on deeper layers and are not a good treatment that thin-skinned area.

But, that’s not the case with Intense Pulsed Light (IPL) or a treatment that is often called a Photo Facial.

IPL is a non-laser light that seeks out brown pigment – resulting from sun damage – and pesky blood vessels. The light breaks up the pigment that gives the brown spots and blood vessels their very noticeable color.

The smooth, unmarked results usually become apparent in three to four weeks.

And that allows admiring eyes to concentrate more on the new breast enhancement!

Now, new research shows breast feeding is more important than anyone ever thought to mom’s health, too.

But what about nursing and cosmetic surgery on the breasts like:

• Breast augmentation
• Breast lift
• Breast reduction

Will any cosmetic plastic surgery procedure on the breasts affect a woman’s nursing ability?

Its’ an important question because the research has revealed that breast feeding may even lower a woman’s risk of the big C.

The August issue of the Archives of Internal Medicine, a professional publication for doctors, carries an article about 60,000 women in their 60’s and their health conditions compared to whether or not they breast fed their infants.

Results? Women who breast feed their babies – even for small amounts of time – may lower their risk of developing premenopausal breast cancer – even if they have a family history of the ailment.

The study group who nursed their infants for a year were found to be:

• Nearly 10 percent less likely to have cardiovascular disease
• Very less likely to have heart disease risk factors
• Less likely to have high blood pressure
• Less likely to have diabetes
• Less likely to have high cholesterol

(Read more about the breast nursing study.)

In the vast majority of cases, breast augmentation patients will be able to nurse normally.

Note: If you have nursed in the year before your surgery, a slim possibility exists that you may produce milk after your operation. Your surgeon can prescribe a medication to treat the condition.

For a breast lift or mastopexy, your surgeon will ask if you plan on having more children.

Due to the rigors of pregnancy and nursing, the lifting effect of mastopexy can be undone. If you think you may nurse again, tell your surgeon; a breast lift does not automatically destroy the ability to nurse.

In breast reduction, excess fat and glandular tissue is removed from the breasts while the nipple and areola, the colored areas around the nipples, are moved upwards.

While all that is great for the mother — the weight of abnormally large breasts causes other health woes – some women may be unable to nurse afterwards. Be sure and talk to your surgeon about breast feeding.

Read the story of one mom who had breast reduction and did nurse.

Fat taken from where you don’t want it and then applied to the places where it is highly desired – and desirable!

The patient's fat was used for breast augmentation. The after picture, right, was taken seven years later. PHOTO: Sydney Coleman, M.D.

In the United States, fat transfer to enlarge the breasts is getting more serious attention, according  to Denver’s Dr. David Broadway who blogs that the American Society of Plastic Surgeons’ task force on fat grafting has made a positive recommendation to surgeons about “proceeding with caution.”

However, for many decades, France, Brazil, Italy, Japan and a few other nations have been going full force ahead with breast enlargement, using the patient’s own fat instead of a breast implant.

Recently, two plastic surgeons, one French (Yves Gerard Illouz) and the other Brazilian ( Aris Sterodimas), studied 820 fat transfer breast augmentation patients from 1983 to 2007.

From the get-go, the surgeons admitted the procedures shortcomings:

• Transferred fat is often reabsorbed
• Fat sometimes dies and forms cysts of calcium
• The calcium can block mammograms and hide cancer

The 820 plastic surgery patients, ages 19 to 78, were divided into three groups of:

• Breast reconstruction patients with unbalanced breasts
• Patients born with uneven breasts
• Patients who just wanted breast augmentation

The subjects all signed consent forms outlining potential complications of injecting fat into the breasts.

Following the patients after their breast surgeries for 25 years and giving them mammograms at the six-month and one year points after the surgery, the doctors found:

• 12 hematomas, pooled blood under the skin
• 5 infections
• 76 cases of black, blue and purple bruising (ecchymosis)
• 34 cases of long term unbalanced (asymmetry) breasts
• 36 cases of striae, or off-colored stretch marks

Most complications showed up at the six-month point.

The doctors caution that the treatment has to be performed in stages with small quantities of prepared fat injected into the breasts at each session.

“The way to prevent complications is make sure the patient’s final result is not the aim of a single procedure,” wrote the doctors. Three sessions usually do the trick

According to the doctors, the procedure is predictable and satisfying as long as surgeons use at least three sessions.

(Read more about breast augmentation via fat transfer.)

In cosmetic plastic surgery, the equivalent of the sample is a set of before and after breast augmentation pictures.

When we told you in a previous post about breast enlargement with Macrolane , we did not have any samples to show.

Now, a British lass has solved that. A plastic surgeon, entertaining a very select audience, brought out an extremely, shall we say, bosom challenged young miss and then took her away for Macrolane injections.

Five days later, the surgeon then fetched his lovely subject back before the same group, to complete the before and after viewing experience.

And we’ve got the pictures!

Look for yourself how quickly – and naturally — a Macrolane breast enhancement takes effect.

Such a shame the Macrolane goes away in one to two years!

With over half a million U.S. women undergoing some form of breast surgery yearly, according to the American Society of Plastic Surgeons (ASPS),  plastic surgeons and others want to know exactly what makes breast surgery patients happy at the end of the day.

So five researchers from Canada, the United States and England interviewed 48 breast surgery patients, who had:

• 15 breast reductions
• 12 breast augmentations
• 21 breast reconstructions

The patients were chosen at random from the practices of four plastic surgery practices in Vancouver, Canada.

The basic task was for each patient to describe the condition of her breasts and how the subsequent surgery impacted their lives.

Results: Six themes came out of all the interviews, including:

• Satisfaction with breasts: Women who were happy with breast size, shape, symmetry, cleavage, scars, positioning, how natural the breasts look and feel and how the breasts fit the rest of the body were key concerns.
• Satisfaction with the overall outcome
• Psychosocial well-being: Patients rating high levels of well-being were pleased because, after surgery, they felt less embarrassed, more confident in social settings, more self-assured and more feminine and attractive.
• Sexual well-being: The subjects said they felt more sexually attractive when clothed and unclothed. They were more confident sexually and more satisfied with their intimate lives. Said one breast augmentation patient: “What I find now is that I am sensual, which I did not feel before.”
• Physical well-being
• Satisfaction with the process of care: Attention plastic surgeons and office staff: According to the study, breast surgery patients mainly look for the amount and quality of information they get before surgery; the actual care provided by the surgeon along with the office staff care. Responded one patient: “And once I came home, the home care…the nurses would come round and they were just excellent..”

(The movie’s ad tag: “Never before has one invention given America such a lift!)

The video paints one of the surgeons as a get-rich-quick-artist who spots a surgeon friend’s invention – the silicone implants – as a way to fame, fortunate and a burgeoning 401k account.

What actually happened back in the ’60s was that the two surgeons  — one was a professor of plastic surgery — first tried injecting silicone into the breasts. But after seeing the terrible results on 11volunteer patients, they gave it up.

With the first implant in hand, the doctors came across 26-year-old Timmie Jean Lindsey, a mom who had four children in nine years. That left Timmie Jean with sagging breasts.

She also had a small tattoo on each breast and went to see one of the plastic surgeons for dermabrasion removal of the tats. The surgeon said he had developed  a new breast rejuvenation procedure for women who had many children. But Timmie turned him down, saying what she really wanted was an otoplasty to pin her large ears back.

Eventually, the surgeon agreed to do the otoplasty for no charge if Timmie would have the breast implants. She agreed, increasing her breast size to B from a C, and became the world’s first cosmetic breast augmentation via implant patient in 1962.

Recently, Timmie told the Daily Mail in London, England, that after the procedure, she suddenly got tremendous attention from men and soon married again. (Read the breast implant story.)

The condition of Timmie's breast are shown, extreme left, before surgery; middle, two months after the procedure and two years later.

But after ten years, her breasts became hard – probably due to capsular contracture, a type of internal scarring and the most common complication in breast augmentation.

(See our previous post on typical breast enlargement complications and how to deal with them.)

Timmie, now in her eighth decade, still has problems with her 45-year-old implants but does not want to risk surgery due to her age.

And the surgeons? They sold their invention to Dow Corning in return for royalties.

Although Dow Corning no longer makes breast implants, two other medical manufacturers picked up the slack.

Now, the most current plastic surgery statistics available reveal that breast augmentation is the U.S.’s leading invasive cosmetic plastic surgery, with about 307,000 patients counted in 2008.

Plastic surgeons there are using a thick, gel-like substance, Macrolane, made of the same chemical compound as the familiar Juvederm.

It’s made by the same Swedish firm that makes Restylane.

Injected deep into the breasts, Macrolane breast enhancement really is an augmentation without the knife. Of course, this procedure has its plus and minus features, too.

Upsides include:

• Recovery is nil

Walk in, have a one to two hour procedure, walk out

• It looks good

Macrolane is said to provide substantial volume and provide a smooth appearance to the breasts without lumps or bumps

• Few risks

The risks of general anesthesia and surgery (infection, scarring, broken implants) are gone.

The downsides are:

• Not approved yet for U.S. use
• Effects only last one to two years (British doctors include yearly “top-offs” to maintain the look.)
• Not for those allergic to hyaluronic acid
• Women who have the procedure are monitored

Many women now in their 40s and 50s who had breast augmentation while younger no longer want large bosoms and often have surgery for smaller implants.

If those women can afford to go back every two years for Macrolane, they would not have to worry about explants surgery later on.

Explore Plastic Surgery, the most excellent blog of Indiana board-certified plastic surgeon Barry Eppley, M.D., says injecting Macrolane is “very much like injecting jello.”

Dr. Eppley compared breast augmentation before and after pictures of both implants and Macrolane. His opinion?  “Macrolane fares poorly compared to breast implants.”

For a preview of coming attractions, here’s a British You Tube segment, below.

The segment starts with a low cringe factor as the surgeon uses a tiny syringe to inject what is probably a pain killer.

That thicker, foot long instrument he puts into the patient’s breasts is not a needle but a blunt end canula, a thick, hollow tube that injects the Macrolane jell deep into the breasts. (Watch the Macrolane breast augmentation.)

Dr. Eppley says Macrolane will probably be used in the United States soon.

But the real danger he sees: the stuff is so easy to use, more untrained hands may take advantage of “quick and cheap” factors to produce shoddier breast augmentations.

While the vast majority of breast enlargement patients were happy with their surgical outcome, breast surgery is like any other surgery: even in the best of hands, unforeseen complications can crop up.

So what are the signs a woman might notice in herself that something has gone wrong after breast augmentation?

Warning signals include:

• Changes in nipple sensation

Several invasive cosmetic plastic surgeries – like breast enlargement and liposuction – can leave the skin in the treatment area with a slight numbness. It’s almost always temporary because the nerves grow back.

• Fever

A high fever can be more serious because it may indicate an infection. Other signs of infection include redness around the incisions. If you notice that in your incisions, you should call your surgeon right away. If he or she is a board-certified plastic surgeon, that doctor will have seen – and treated – all the possible complications.

• Muddy mammograms

Tell your radiologist you have breast implants; sometimes, one or both implants can obscure the X-rays. But additional pictures from different angles can be taken.  Ultrasound or magnetic resonance imaging can also be done.

• Hardness of the breast

The natural healing process can form scar tissue that surrounds and squeezes your implants in varying degrees. That can cause the breast(s) to feel tighter than normal. Your surgeon needs to evaluate it sooner rather than later.

• Changes in breast size

If a breast looks like it is deflated, it could be because the implant has leaked. For a saline implant, the filler leaks harmlessly into the body. Your doctor needs to know because surgery may be required to replace it. The good news? Many implants have warranties.

• Sickness after surgery

The best way to prevent nausea after your procedure is to make sure you have a board-certified anesthesiologist.(Tip: use a little doctor slang and ask your surgeon who the “gas passer” is going to be. They’ll both be charmed by your insider knowledge!)

The best way to handle complications: discuss them before surgery with your surgeon and ask the doctor who would beresponsible for what treatments in case one of these rare complications rears its ugly head.

In this video, Jennifer, a young middle school teacher with four toddlers, sees a Minnesota plastic surgeon for breast augmentation and goes ahead with the procedure. Like many moms, Jennifer only wants to restore her bosom to where she was before marriage and children. It’s non-gory, G-rated, has very minimal nudity and wonderful classical music.

View the breast augmentation video.

If it sounds too good to be true, it just may be.

Anyhow, women – make that clothed and semi-clothed women — who are in the market for a breast enhancement post their pictures at MyFreeImplants.com and plead their case, telling what it’s like to go around as a sweet young thing with no confidence in a womanly appearance.

For $1.20 a pop, “sponsors” can write to the girls, look at their pictures and even buy items once owned by the young women. Sponsors also donate larger amounts of money until the price of the procedure is met. One woman on the site blogs that her breast implant donations were a little over $12,000. Sometimes, it takes a year to raise the funds.

Women who raise sufficient donations can use any plastic surgeon they wish although the site lists about 40 U.S. physicians, many of whom are board-certified plastic surgeons.

Then, readers of the website, who are 99.9 percent men, donate whatever they can until the cost of a breast augmentation is covered. After that, the newly endowed girls and women – still semi-clothed, mind you! – post their before and after breast augmentation surgery pictures and gush their thanks to their many benefactors.

One group gushing nothing but criticism, however, is the British Association of Plastic Surgeons (BAAPS) who finds the procedure degrading and says that “there is no proper medical assessment of breast augmentation candidates, which at best could be a disappointment, at worse, to someone’s health being endangered.”

But doing the right homework should take care of itself. (Read more about finding a qualified plastic surgeon.)

Our real concern: in the age of the Craig’s list killer, the women showing their faces and tantalizing peeks of their bodies on the website could be tempting a very dire fate, even though the website claims to protect their privacy.

Some are fully identified by name and location when they give newspaper interviews while many Internet stalkers – depraved as they are — have the skills to trace people down through I.P. addresses and by other methods.