Some plastic surgeries similarly lie in a gray zone between necessity and medical enhancement. For example, breast reduction is seen by many in the United States as medically justifiable. But in Brazil the operation often has mainly a cosmetic aim (small breasts are an erotic ideal, while larger breasts are seen as matronly). Reconstructive surgeries such as breast implants following a mastectomy also concern aesthetics. As with cosmetic augmentation, the goal is not to improve function but appearance. Of course, breast cancer patients are usually seen as medically entitled to implants, which, not surprisingly, are often available for free.

Still, classifying breast implants as reconstructive does not mean they are less risky. At least a fifth of the French women with PIP implants received them after mastectomies. Calculating risks with any form of plastic surgery is difficult because it depends on weighing potential harm to the body against improvements to intangible qualities such as sexual and psychological well-being.

Perhaps the latest implant scandal is just a misstep on the path to greater safety in aesthetic surgeries. In 2006, the FDA ended a 14-year moratorium on silicone implants with the approval of two new models. Shortly after, breast augmentation became the most commonly performed cosmetic surgery in the U.S.