At the clinic of a plastic surgeon in Mumbai, Hetvi Patel of Rajkot looks buoyant.

Until eight months ago, 26-year-old Hetvi, now in a pair of jeans and a snugly fitting T-shirt, was depressed about breasts she found too unassuming. So like many women her age, she decided to go to Mumbai for a breast implant. And it worked. Five months later, she got engaged, bringing an end to rejection slips from prospective grooms.

Breast augmentation surgeries, which have long moved from being the preserve of the rich and the famous in big cities, are spilling over into the periphery. While the numbers may still be lower than those in the metros, the reasons why women, ranging from college students in their mid-teens to bank and call centre employees in their twenties, seek heavier breasts are no different: marriage partners, fame, recognition — or to keep their husbands from straying.

“The popular concept of beauty is a big bosom,” says Mumbai plastic surgeon Satish Arolkar.

In Calcutta, over the last two years plastic surgeon Pradip Sen has been seeing three or four 18 to 24-year-olds every month who come from the remote districts of West Bengal for breast implant surgery. And like their urban counterparts, they’re educated and aware of what to expect, having worked the Internet search engines before hitting upon a suitable plastic surgeon. “They are more demanding, exacting and ask questions,” says Sen.

While many try to keep their families out of it, a good number of women do come with an approving mother in tow, adds Sen. While many surgeons would charge Rs 30,000 to Rs 40,000 for breast implants, at the lowest end they could come as cheap as Rs 16,000. “If not for cost constraints, there would be three times more women undergoing breast augmentation,” says Sen.

The less preferred saline-filled implants are cheaper than the silicone gel-filled ones, which faced a 14-year moratorium in the United States for their alleged cancer-causing links. In 2006, the US Food & Drug Administration approved a new generation of improvised silicone implants like the cohesive gel one.

In some small cities, the rise in numbers has been far more noticeable. For instance, in Dehra Dun, plastic surgeon Rakesh Kalra has been conducting 30-40 breast implant surgeries a year, as against two or three about five years ago.

In Jaipur, aesthetic surgeon Akhilesh Sharma cites an overwhelming boost to his practice over the last couple of years — up from five or six cases a year to the same number in a single month. Mahendra Tiwari, an agent in India for the UK-made Nagor breast implants, emphasises that the future of his business lies in cities such as Varanasi, Indore, Bhopal, Aurangabad, Solapur, Kolhapur, Surat, Baroda, Madurai and Lucknow.

In Aurangabad, surgeon Ramakanth Bhemde markets breast augmentation through his hospital brochure, circulated in neighbouring urban and rural pockets. Those interested are even shown video clips of the surgery. In Rajkot, many of aesthetic surgeon Bhawmick Bhayani’s patients come from the talukas.

A lot of women — such as Hetvi Patel — seek the anonymity of a big city for surgery such as this. But, the doctors point out, the reverse is true as well. Rajendra Nehete, a plastic surgeon in Nashik, says he sees patients from peripheral Mumbai, just as many of Jaipur surgeon Malti Gupta’s patients come from Gurgaon and other parts of Haryana.

The experts point out that not all women seeking breast augmentation are young. Some are middle aged, and many among them see the surgery as a way of keeping their husbands interested in sex. Even well educated men, emphasises Pramod Mahajan, a plastic surgeon in Nashik, seem to be hung up on big breasts. “It is intimately linked to their personal happiness — to keep the sex life going well into their 30s and 40s.”

Even in back-of-beyond Latur district, Varsha Hasgude sees three or four women in their 30s every month who, prompted by their husbands, come to her for breast augmentation.

But the results do not always bring joy to the woman, as much as to the man — as Aurangabad surgeon Bhemde has seen. It is not uncommon to find housewives going through discomfort and feigning happiness for the sake of the husband, he says.

For those women getting implants without their husbands knowing, the age of minimal scar surgery is on their side. They successfully pull it off when the implant is inserted through an incision in the infra or sub-mammary crease on the underside of the breast. This method is more common than inserting the implant through the armpit or areola, say doctors.

Nowadays, manufacturers of breast implants protect their interests, insisting that the incision in the breast be not less than two inches long to avoid damaging the implant, says Arolkar of Mumbai. A few companies offer a 10-year warranty on their implants.

Many women, such as Hetvi, who went from a 32A to 32C, would prefer a subtle enlargement, by opting for a C-sized cup. But there are also those like aspiring showgirls from smaller cities who are keen on making it big — literally as well as figuratively. Arolkar says for women who want a bigger bust size, the implant is placed just beneath the tissue of the breast, rather than the muscle.

But as many have seen, breast implants cannot be a girl’s best friend — at least not for ever. Over time, implants can break down, needing replacement. Both saline implants, filled with salt water solution, and gelatinous silicone implants can rupture and leak.

While there have been women who’ve held them close to the chest for over a decade without major complications, things have soured almost instantly for others. In case of infections, implants have had to be removed. Surgical tune-ups are needed when implants get inverted or move, sometimes as far as the armpit and collarbone, says Sen. “Breasts, after all, are not static,” he explains.

More commonly, the implant can cause the breast to feel tender or even like a cricket ball, Sen adds. This happens when the scar tissue shrinks around the implant, squeezing it. Big, clearly, is not always beautiful.