Sunday, June 13, 2004

On Breast Augmentation

Are your breasts big enough? I bet that you have never spared this a thought if you're a man, while if you're a woman you have certainly considered the likely answer to this question. What if the likely answer is that they are not big enough? Big enough for what, exactly? What do the breasts have to perform that would require a large size? Well, we all know the answer, and it has nothing to do with breastfeeding or with lifting weights with your mammary glands. It has even nothing to do with not being out of balance packwards or any other smart-alecky explanations I can think of. It's all in the eye of the beholder. If the beholder is a man, or, as I am going to argue, if the beholder is a male American*.

Science is wonderful. It has even come to the aid of those women who prefer larger breasts than nature's designs allowed. The operation is called breast augmentation, and it involves cutting the breast tissue open and stuffing it with bags of silicone or bags made out of silicone but filled with a saline solution. Then the breast is sewed up again and presto, you're a cup C or D now! Except that you aren't, not really.

Many women who choose breast augmentation do it for very good medical reasons. They may want to have their breasts reconstructed after surgery, for example. But many others have breast augmentation on perfectly healthy breasts. The medical problem they suffer from is that the society tells them their smaller-than-average breasts are not acceptable.

In fact, what is now becoming perfectly acceptable is to fix this size problem with surgery, even for girls under the age of eighteen whose breasts may not have actually stopped developing. Bigger breasts is a fashion item, something that would make a nice high school or college graduation present, and if mum and dad won't pay for them, well, there's always loans:

"When I graduated high school in 1990, the big thing was nose jobs," said Jo Trizila, director of media relations for the Greater Dallas Chamber. Now, 8 of her 10 friends have implants. Those who couldn't afford them took out a loan.

But getting breast implants is not like buying a new color of lipstick or eye shadow. Breast augmentation means surgery, anesthesia and recovery from surgery. All the usual risk factors of surgery and anesthesia apply. Add to this the possible side effects from having foreign material in your body, and the fact that no breast augmentation is for ever: practically every single patient will have to undergo more surgery later on in life:

Whether you are undergoing augmentation or reconstruction, be aware that breast implants are not considered lifetime devices and that breast implantation may not be a one-time surgery. You are likely to need additional surgery(ies) and doctor visits over the course of your life. You are also likely to have surgery to remove the implant with or without replacement sometime over the course of your life.
Many of the changes to your breast following implantation are irreversible (cannot be undone). If you later choose to have your implant(s) removed, you may experience unacceptable dimpling, puckering, wrinkling, loss of breast tissue, or other cosmetic changes of the breast.
Breast implants may affect your ability to breast feed. Also, breast implants will not prevent your breast from sagging after pregnancy.
With breast implants, routine screening mammography will be more difficult, and you will need to have additional views, which means more time and radiation.
Breast implant surgery and/or treatment of complications may not be covered by your health insurance. You should check with your insurance company regarding these coverage issues because, for some women, health insurance premiums may increase, coverage may be dropped, and/or future coverage may be denied.

The average cost of breast augmentation is 7,000 dollars in the United States. That would buy a lot of padded bras, and the amount is just for the first operation. Then there are all the possible things that might go wrong with breast implants: capsule contracture, capsule deflation/rupture/leakage, infection, hematoma/seroma, extrusion, necrosis and so on. While none of these effects occur in an extremely large number of cases, there is some cause for concern if breast implants are viewed as an innocent fashion item rather as a medical option with all sorts of nasty risk factors.

Now I'm beginning to sound schoolmarmish and prudish. But I hate to think of people unnecessarily exposing their bodies to all that cutting and drugging. There's plenty of opportunity for all that later on when the bodies get old. And I do think that the reason for much of breast augmentation is an unnecessary one: there is nothing medically wrong with smaller breasts; they might even be less prone to breast cancer than larger ones. But I'm not telling anybody not to undergo this surgery if they wish to. It's not my breasts that are being cut, and I can't know how someone must feel to voluntarily undergo such cutting. I just think that the culture could focus on something else than the female breast as a sexual marker for a while. Give us some breathing room, if you like.

This culture is largely the Western one. The Breast isn't that important in some other cultures. The Japanese traditionally found the nape of the neck in women the part that aroused men's sexual instincts, the Africans and Caribbeans tend to focus on the buttocks. Even in the Elizabethan England bare breasts provoked very little comment, as it was women's thighs which made men's hearts beat faster. And I can tell from my own multi-continent experiences that it is the American men especially who are mesmerized by the Breast, preferably a largish one.

That the focus on mammary glands as a sexual marker is so culture-bound is important to stress, as some wingnuts argue that breast augmentation is a natural evolutionary strategy for women to compete against each other in the search for the Best Sperm. This would make it unfair competition, by the way, but that's not the point of their argument. Rather, they imply that the yearning for better and bigger breasts is biological and therefore Just The Way Things Are. They are mistaken, as I so aptly point out in the preceding paragraph. The Breast is not somehow the naturally designated measure of a woman's sexual desirability; we have made it so in this particular culture.

What's worrying, too, is that fashions about breasts could change. Maybe suddenly breasts aren't the IT thing anymore, and then all the women who spent money on better breasts are no better off than they were initially. Of course, the culture would then tell women to carve out their thighs or to round out their noses or something, so a change in the fashions isn't a real answer. I don't know what the real answer would be. But it would help if we realized that this fixation on the Breast is a cultural one, and that there is much more to the sexiness of the body. It would also help if we all agreed that the breasts belong to the woman to whom they are attached, not to the advertizers or the movie industry or the pornographic industry or the FCC. But that's probably too much to hope for.

*I'm aware that many men are not fixated on large breasts, and I apologize for using the generalization device in this post. The reason is purely stylistic, as you will see if you try to amend the offending sentences.