So your bff goes in for breast augmentation or your other gf has a nose job. Of course, you notice, but exactly what do you say? A proper response can be awkward so why not let the professionals say it for you and send a plastic surgery greeting card?

Leading the way several years ago was the aptly named Lift Me Up Cards with greetings for gal pals who had:

• Breast augmentation (Congratulations on the Twins!)
• Breast lift (“I Thought You Needed a Little Lift. But it looks like your plastic surgeon already took care of you!”
• Rhinoplasty (“Your Nose Looks Great! You picked a great one!)
• Liposuction (“I Thought We Could Sit Around and Chew the Fat. But since you had liposuction, that’s not a good idea!”)
• Tummy Tuck (“Congratulations on Your Tuck! Now, no more Roll!)
• Face lifts (“You Look like a Million Bucks! I hope it did not cost that much to look so great!”)
• Sclerotherapy (“You’re So Vein. You probably think this card is about you!”)

And because imitation is the most sincere form of flattery, other plastic surgery greeting cards have entered the fray. Greeting Card Universe, for instance, offers congratulation cards for:

• Cosmetic Surgery
• Your Boob Job
• Your Breast Reduction
• Your Face Lift.

One card for breast augmentation patients shows a puzzled youngster on the front saying, “Gee whiz…I always heard of people making mountains out of molehills.” When you open the card, it says: “I just never knew anybody could really make it happen!”

Yet another card obviously intended only for woman-to-woman mailings says on the cover: “So you got some new Boobies, eh?”

Open the card and it says inside: “Can I have your old ones? Wait, I already have old ones!”

(Browse other plastic surgery greeting cards.)

But save a life?

It actually happened when a mother of four little children was trapped under her massive N-size cup breasts for half a year.

The strange case happened in a remote area of Northern Peru when a five-foot tall woman, Julia Manihuari, 29, found her breasts continued growing after the birth of her third son.

According to news reports, Julia’s breasts caused her to faint if she tried to get out of bed; Julia, who admitted to having always had a small body build, said the stress of the breasts caused her absolute agony.

“My breasts were growing daily,” said Julia Peru. “My skin had sores and I had trouble breathing.”

By comparison, the Guinness world record holder for largest breasts ever belongs to a Florida exotic dancer who claims to have triple M breasts.

In Peru, Julia’s doctors at the Loayza Archbishop Hospital in Iquitos – in the Peruvian rain forest —  had more serious concerns. First, they announced that the diagnosis was an extreme form of bilateral gynecomastia. But that was probably an error in translation because gynecomastia only occurs in males.

Julia’s doctors probably meant gigantomastia, which is the rapid growth of the breasts usually concurrent with pregnancy, according to Dorland’s Medical Dictionary.

Naturally the doctors were worried that the huge weight would crush her lungs.

Such a condition is VERY rare and only happens in about one in every 28,000 women.

After six months of being bed bound, word about Julia’s plight eventually got out, donations poured in and a trip to the nearest hospital was organized.

During a six-hour operation, doctors found the breast reduction was more complex than most because they had to work around many extra blood vessels which had sprouted in the breasts.

(Learn more about the unusual breast surgery.)

Eventually, they removed 35 pounds of flesh, fat and tissue, leaving Julia with much more manageable 34B breasts and freeing her from entrapment in her bed.

A recent survey revealed that some patients have very active imaginations and can come up with some, well, very unusual questions.

Here are the top 5 off-the-wall questions that patients have asked:

1.) If I ski or camp in the snow, can breast implants freeze?

In a word, no. That is, unless the rest of your freezes, too!

Breast implants are in a very warm, comfy environment. Even if your whole body, your silicone implants – being oil based – would not freeze. Your saline implants – being largely salt water – would only freeze if you succumbed while sleeping outside in below zero weather.

2.)  If my husband gets, ah….excited during, ah, intimate moments and squeezes my breasts hard, can the implants break or take a different shape?

Again, no way, unless your hubby’s name is Superman. Provided the implant has been put in under the pectoral, or chest, muscle, your main man feels your natural breast tissue.

3.) I only see women in your office, doctor. Has a man ever had breast implants?

A professional gambler once took a $100,000 bet that he could not survive one year with size 38C breast implants in his chest. He took the bet, collected the 100K and then wrote a book, The Man with the $100,000 Breasts. The gambler/author said women were fascinated.

4.) Can a guy tell if I’ve had breast enhancement? Will he care?

He will be able to tell if:

• Each nipple points to the closest armpit
• Ripples show through the skin
• The breasts are two different sizes
• You have no cleavage
• Scar tissue forms around the implants, making the breasts hard

According to a woman’s magazine survey, 83 percent of guys don’t like breast enhancements.

5.) How can guys tell if I’ve had breast enlargement?

When a breast implant patient moves around or reaches up, her breasts keep the same shape. Natural, unaugmented breasts will flatten when you put the arms over your head or fall forward when you lean over. Not-so-good implants look round and hard like a grapefruit halves. Undoctored breasts hang, more like water balloons.

That means people find uses for products the manufacturers completely missed. Any New Yorker  knows right how valuable kitty litter is for getting a grip on icy sidewalks.

The latest law of unintended uses? Breast implants as body armor.

Back in 2006, Israel was undergoing rocket attacks. Emergency surgeons at Nahariya Hospital reported they found shrapnel from an exploded rocked imbedded in the silicone breast implants of a 24-year-old. “The fragments were just inches from her heart so the implants saved her life,” said a spokesman. (Read a blog about shrapnel-catching breast implants.)

Our take: silicone is very thick, most shrapnel fragments are jagged but flat and don’t penetrate the body very deeply. Mostly likely true.

Another instance happened in Bulgaria, also in 2006, when a woman had a head on collision with another car. A policeman reported her double D implants absorbed most of the impact, protecting the driver’s ribs and vital organs.

Our take: Probably true. (We sure wish a doctor had backed up the police report.) Read the breast implants as airbags story.

The most current implant-as-body-armor instance happened when an L.A. woman was shot point blank by a crazed gunman who attacked a dental office where his wife was working. Another victim was shot in the arm and then played dead. But the gunman allegedly aimed directly at her heart and fired. A cosmetic surgeon later reported the implants saved the woman’s life.

Our take: it probably did not happen like that. Most assault rifles fire a high velocity bullet that, at close range, would zip through any implant, through the victim and then into and through yet another person.

What probably happened: The hospital spokesman where the victim was treated reported spotting bullet fragments only millimeters from her heart in a CT scan. So she was probably hit by a ricochet bullet that had lost most of its energy. Or the bullet struck the victim’s necklace and broke up. (Read the size D Implants article.)

Nonetheless, she should consider herself very, very lucky.

Adding to her luck was a kindly Beverly Hills cosmetic surgeon who offered to do for  no, or low, fees a reconstructive surgery when the victim healed.

Morale? Nobody should ever get saline implants or silicone implants with the idea of acquiring an internal bulletproof vest!

• Saved long and hard
• Compared board-certified plastic surgeons
• Studied before and after breast augmentation pictures
• Arranged the rest of the financing
• Had breast enhancement surgery and the healing process

And now, “the girls” look like the ones you’ve always dreamed of having.

Virtually all plastic surgeons would advise wearing a well-constructed brassiere to protect your investment.

Well, O.K., to protect and perhaps showcase it, too. After all, a little pride and confidence in one’s appearance is part of what cosmetic surgery is all about, right?

Entering that delicate space and bringing a very special bra to the attention of the world is the annual parade of the 2009 Ig Nobel Prizes.

The Ig Nobel Prizes usually feature real, but off-the-wall, scientific studies like:

• A study inquiring if more damage to the skull is done with empty or full beer bottles
• An academic finding that cows with names give more milk than nameless cows

Not too many Ig Nobel Prizes apply to plastic surgery, but for the first time ever, a dual-use bra has captured a prize.

Announced on October 1st at Harvard University, the winner of the Public Health Prize category Elena Bodnar, M.D., demonstrated her winning invention, a regular bra that performs its intended normal support function along with a gas mask application.

Yes, you read that right – this bra doubles as a gas mask.

If things should go seriously South and a threat to breathing crops up, the bra can almost instantly be converted into two gas masks.

Dr. Bodnar is entirely serious and told a Discovery Channel interviewer: “The bra makes you laugh at first and then think.”

She wants you to think about being prepared. Not only for the sagging that eventually goes along with advanced aging (long after your breast enlargement, of course) but for emergencies too.

The beauty of the concept is that, in any crowd, at least 50 percent of the people present are wearing bras.

(Attention shy women: the bra is designed to come off under your clothing; there’s no need to undress in public.)

And if some untoward event, oh, like a gas leak or a huge dust storm crops up, more people would be able to escape to safety

That is, if all the women at the scene were wearing one of Dr. Bodnar’s bras.

(Attention skeptics: Dr. Bodnar is a real doctor and highly respected scientist who researches electricity’s effect on the human mind. Here is her latest scientific research.)