Everything is beautiful at the beach on Isla Barú, an island about an hour boat ride from Cartagena, Colombia. Beautiful water, beautiful views, beautiful women. We were in a small group for a wedding of a dear friend, where uniformed waiters brought us drinks by the pool. After her second glass of rosé one of the women idly asked: Of the 200 people on this private beach, who’s had plastic surgery?

Everyone—guys and girls—started calling out “9 o’clock,” “my 7:30,” “mediodia.” Some women’s breasts seemed to burst out of their tops, some belonged to first-time mothers. And then one girl mentioned her modestly breasted friend. “You all know about Karen, right?” Karen walked by us in a bandito bikini top, a scrap of bathing suit with zero cleavage. But somehow under there she managed to hide a five-figure surgeon’s visit.

It got me thinking that everything I thought I knew about breast implants is wrong. So I started asking around. Turns out: Just as no two women have the same breasts, no two women have the same reason for wanting new ones.

A common denominator in getting breast implants is maintaining a strong sense of self—regardless of reason.

When I got home I called Raquelle, a former girlfriend of mine who left town a few years ago. We’re still friendly. After years of working two jobs through school, Raquelle started to make a decent living and decided to go for it.

Raquelle and I were definitely in “second date” territory when I even realized she’d had the surgery. Her close friends never knew. She is a shapely blonde woman with teardrop breasts like the sexy silhouette on the mudflaps you see at rest stops. “I forget that I ever saw a doctor really,” she says. “They’re just part of me… It was stressful for me to ‘plan around’ them before. Can I fit into this dress? Now, I just wear whatever I want.”

Raquelle chose a size that worked for her, so her wardrobe would work. Most women choose their implant by using “sizers”—bras fitted with the implant size. Also, for the curious: If you use a regular metric kitchen measuring cup you can try out your own implant sizes at home. For example, 400ml=400cc implant and, to gauge the size, just pour it into two plastic bags.

Jane, a fitness instructor and self-described “workout-a-holic” never got used to the changes in her body after having kids. She worked out three hours a day and still had a flabby belly, so she had her breasts done along with a tummy tuck. Now she has a confident hourglass figure and she likes what she sees when she looks in the mirror. And now she makes more money seeing private clients, many of them new mothers, as well.

“I like boobs, I like the look of fake boobs—we could afford it, so we started going to consultations,” adds Meredith, a woman who paid for her surgery with her then-husband. “But what really made me do it was thinking, in five years, would I regret not getting them done? I thought a lot about that question. My answer was always the same: I know myself and, yes, I would have regretted letting the opportunity slip by. So I got the implants.”

Everybody has days when they look in the mirror and because of one reason or another—time to shave, too much booze, lasagna—they don’t see themselves reflected. It’s the ultimate mind/body conundrum and, as I dug deeper, it became apparent that a common denominator in getting breast implants is maintaining a strong sense of self—regardless of reason.

You could ask a dozen women about why they got implants and what their experiences have been, and they would all have a different answer. So I decided to go to the source. Dr. Matthew Schulman received his M.D. from Jefferson Medical College and completed his training in general and plastic surgery at The Mount Sinai School of Medicine at New York University. And he answered a few of those burning boob questions.

And I realized more and more that plastic surgery is like sex: Because we never talk about it, way too many of our references come from porn.

Dr. Schulman has done over 3,000 breast augmentation surgeries. He steers his clients towards the shape-lifting but conservative 300-500cc silicone implants. “The data shows the larger the implant, the bigger the complications,” he says. “It can cause changes to the ribcage. When we take large implants out, the ribcage has a dent in it… If you try to put an implant that’s too big for her body, you’re going to have problems. I just got an email from a woman with a 1,000cc implant and she wants to go bigger.”

Most women put the surgery on a credit card and pay it off over time. And to them, it’s worth it.

“We’re more image-conscious and not ashamed—millennials are very open to sharing things like this,” he explains. “About 20 years ago a woman would get surgery and never tell anyone. Now she’ll post an Instagram from my office.”

And let’s be clear: A woman can and should do any freaking thing she wants with her own body. But I’d heard that the surgery causes women to lose sensation in their breasts. Imagine that. You’re doing your best Cosmo second-base foreplay and she’s getting nothing out of the equation? If so, we must look like a bunch of boobs.

If [sensation loss] happens, it is not reversible,” Schulman warns. “If you make the incision near the areola, it is more common. There’s a 25 percent chance of a change in nipple sensation.”

What he actually finds is that, of those women, half have decreased and half have increased sensitivity.

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Of course, for many women, nothing changes in their sex lives—or in motherhood—at all.

“I never experienced that,” says Leila, a former Vegas dancer with 650cc implants who later breast-fed two children with the implants. “I’ve breastfed my daughter for almost 20 months and I’ve seen little to no change. I found that abruptly stopping breastfeeding my son while I was severely engorged caused more damage than when I stuck with it with my daughter and allowed my breasts to gradually decrease in size.”

I wanted to ask one more woman I know, so I reached out to Josie, a friend of a friend and Vegas showgirl who had straight up Dr. Strangelove missiles strapped to her chest. (“Probably two 500cc implants stacked on top of each other,” Schulman guessed.) I say had because the last time I saw her she had backed off from the 1,000cc implants and gone down to just a D-cup.

“Nothing fits when you’re that big, other than big frumpy T-shirts,” she says. “I had them for 10 years and that was enough.”

In fact, a lot of women remove their implants because they just aren’t practical anymore. Little things start to become pains. For example, sports bras: Those reliable breast-management devices become impossible as silicone doesn’t squish down the way natural breast tissue does. As Dr. David B. Reathe, plastic surgeon in Knoxville, Tennessee puts it, “It is very hard to find marathoners who wear a double-D bra.”

It’s not uncommon for women to reverse the surgery like Josie. It’s not only reversible, but it usually has to be redone in five to 10 years, anyway, since the body shifts around the implant. Bigger implants cause bigger sagging. And, naturally, there are some risks involved, which can turn into legitimate issues over time. For example, the silicone insert feels more natural than the cheaper saline kind, which can be over-inflated and, in some cases, eventually explode.

As terrifying as that sounds, a woman’s body actually just absorbs the saline and they’re only advised to go to the doctor as soon as possible to rule out infection.

Doctors do discuss these risks with their patients before they perform the surgery. But, like the many women with whom I spoke, they want what they want. “It doesn’t discourage a single one of them, which is pretty amazing,” Dr. Michael Zenn, vice chief of plastic surgery at Duke University Medical Center, points out.

I’ve realized more and more that plastic surgery is like sex: Because we never talk about it, way too many of our references come from porn. It would be like if you didn’t know anything about pop music and you turned on the radio today to try and understand it. Fake tits are the EDM of cosmetic surgery. Given a few days, you can completely see how someone might be into it. And, given a few years, you can completely see why someone might be over it.