It pains me greatly to admit my weakness for trashy celebreality TV, but I'm outing myself right now. One of my faves is "Bret Michaels: Rock of Love Tour Bus". Not only do I enjoy the delicious pseudo-drama, but I honestly have never seen so many ridiculously augmented lips and enhanced breasts in one place in my life. I can't feel quite as guilty about my guilty pleasure if I can call it plastic surgery-related research, right?

When I recently heard one of the bimbettes from the show announce her fear that the girls' latest challenge designed to find Bret's dream-woman may have resulted in a busted implant, I immediately began to think about the very real risk of implant rupture and deflation (after taking a second to roll my eyes at Melissa's drama-queen way of trying to steal the spotlight from the other girls).

So, what did I do? I sat right down to write an article on breast implant rupture and deflation.

Reports seem to indicate that plastic surgery is taking a hit these days, along with almost every other industry. However, the decline is not quite as steep as one might expect, nor is it as steep as in so many other industries. So what are the reasons for this interesting anomaly?

First, there's the fact that in trying times, people are on the lookout for anything that makes them feel better about themselves and/or takes their minds off of the things that are stressing them out. That's why the entertainment industry usually continues to thrive during a recession, as well as the personal grooming and beauty industries.

Second, there's the fact that certain demographics (i.e., the wealthy) are generally not hit as hard as the rest of us...and this demographic is known to spend more on plastic surgery.

Finally, there's the fact that a struggling economy causes a lot of stress. Stress ages our skin more quickly than any almost any other factor (besides sun exposure and cigarette smoke). That means that there may be even more people signing up for procedures designed to reduce or eliminate the outward signs of stress that show up on our faces. Therefore, statistics are showing that treatments like Botox, dermal fillers, laser resurfacing, non-surgical skin tightening and other minimally invasive light-based procedures are still on the rise, even in these trying economic times.

So when is it the right time to look for a plastic surgeon after mastectomy? Actually, you may be surprised to learn that if you are even considering having breast reconstruction surgery after your mastectomy, the best time to find a plastic surgeon is before your mastectomy. Why? Because then your plastic surgeon can work with your breast surgeon to determine a surgical plan that will make reconstruction easier and more successful.

Tips for finding the best plastic surgeon for your breast reconstruction:

Look for a surgeon who specializes not only in reconstructive surgery, but in breast reconstruction specifically. Ask your breast surgeon for referrals. Another good source for referrals to board certified plastic surgeons is the American Society of Plastic Surgeons. A call to the ASPS at 888-475-2784 can help you find specialists in your area.

Consult with several surgeons. It is important to explore different options and techniques. You will not only have a chance to compare the surgeons' different approaches, qualifications, and personalities, but you will learn more about the types of procedures available.

Ask a lot of questions and do your research. There are certain questions you should ask any plastic surgeon. But in addition to these general questions, there are some questions which are specific to breast reconstruction, including questions about your options for nipple and areola reconstruction. If you are considering implant reconstruction, you should learn more about augmentation with breast implants. If you are considering flap or implant reconstruction, there are concerns about symmetry, breast sensation, breast changes with age and weight gain or loss, and more.

Not all mastectomy patients choose to undergo reconstruction. For those who do, it is important to remember that all plastic surgery has risks as well as rewards. An informed decision is always a better one.

As the demand for larger breasts continues to grow, new breast enlargement techniques continually appear on the horizon. I recently posted a blog on the still-being-studied "micro implants" for breast augmentation, and some people are very excited about the concept. But there are other up and coming new options as well, one in particular that is currently already in use by some plastic surgeons.

In addition to standard breast augmentation with silicone or saline implants, there are some doctors who are now performing breast augmentation non-surgically, via injectable dermal fillers. Because there is some controversy about the long-term safety of the longer lasting and permanent fillers (like Artefill), this procedure is usually done with one of the more temporary fillers (like Juvederm).

The advantages of the "needle instead of scalpel" approach to breast augmentation:

-No general anesthesia or IV sedation is usually needed, so many of the risks of anesthesia are avoided.
-There is no cutting, so nipple sensation, milk production ability, and general nerve function are preserved.
-No recovery time is needed.
-No long term commitment is required because fillers are eventually re-absorbed by the body.
-The appearance is more subtle and natural-looking.

The disadvantages:

-Results are temporary, lasting several months to one year.
-Cost is higher over the long run, since the procedure needs to be repeated.
-The method is not practical for patients desiring a significant size increase (more than one cup size).
-Newer procedures always carry a special risk since they are not time-tested.

An important caveat: Injections of liquid silicone gel, though they are still used (most famously in an underground practice called "pumping"), are illegal in the US and many other countries. These injections are known to cause a number of potentially disastrous complications, some fatal.

See breast augmentation before and after photos.