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Beauty and the Breast

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With breast augmentations now topping the charts for invasive cosmetic procedures, the question that begs to be answered is: has society—men and women both–changed its fundamental concept of female beauty when it comes to breasts.

Words Johanna Marmon

On a recent episode of Bravo’s Real Housewives of Orange County, the cast members (all buxom blondes, with a brunette thrown in for good measure) were hanging out poolside at a beachfront hotel in Fort Lauderdale, Florida. The conversation invariably turned to – what else? – breast implants, and whether or not each of the women had them. The cameras zoomed in for a few seconds on each cast member. The shots, of course, were all below the neck and above the belly button, as if to invite the viewer to make their own decision: did she or didn’t she?

Scenes like this play out on reality television seven nights a week. A popular tabloid even recently ran a double-page spread on all of the procedures each “real housewife” has undergone. Entertainment? Sure. But it points to a more obvious overall trend—the normalization of cosmetic surgery in our society—and to a particular variation of that trend: has cosmetic surgery changed our view of beauty, in particular our appreciation of the breast? If numbers told the whole story, then everything you’d need to know about how society views breast implants these days could be summed up in one figure: 307,000.

That’s one estimate of how many women underwent breast augmentation surgery in 2008. It’s a trend that has been building momentum for the better part of two decades: in 1992, just 32,607 augmentations were reported. Today, breast jobs are the most popular type of surgical cosmetic procedure performed on women—more popular than even liposuction, which last held the top spot in 2005.

To what can we attributed this precipitous rise? For one, doctors report, the procedure has been legitimized. “The breast in our society is becoming normalized rather than highly sexualized,” says Dr. Jane Petro, a cosmetic surgeon in Mt. Kisco, New York who does both augmentations and post-mastectomy breast reconstruction. But Dr. Petro, like most doctors, is quick to point out that the desire for augmentation has to be driven entirely by what the patient herself wants—and not by the whims of her husband, boyfriend or partner.

“It’s a big red flag if a woman comes into the office in the company of a man who tells her what she wants,” says Petro. “Her motivation at that point would have to be very carefully examined. However, if the person is making an appropriate choice, she is doing it to make herself feel better about her body.” Even so, says Tucson-based surgeon Dr. Robert Dryden, breast augmentation consultations are one of few where couples come in together. “This is the one cosmetic surgery where males have tremendous impact. When consultations occur, often two people come in,” he says. “But having said that, we emphasize that the surgery should be something a woman does for herself—to feel more womanly, more feminine.” It’s all about getting the body image a patient wants, says Dr. Dryden.

“With implants [female patients] feel more womanly, more feminine… they might enjoy sex more because they feel more like a woman,.” – Dr. Robert Dryden

Whether or not that body image is directly related to how they want potential mates or partners to see them, however, is another question. The concept of breast implants is hardly new—in their most modern incarnations, they’ve been ingrained in our collective consciousness for at least the last 40 years. The earliest implants, Wikipedia tells us, date back to 1895, when a woman underwent implantation with fatty tissue from a benign growth on her back. By the mid-1900s, a variety of substances had been used cut:to try to modify the shape and size of a woman’s breasts, from glass balls and ground rubber to ox cartilage and strips of polyethylene tape wound into a ball.

The more familiar silicone implants were developed by a pair of Texas plastic surgeons along with the Dow Corning Corporation in 1961, with the first woman implanted in 1962. In response to demand for a more “lifelike” implant, the silicone “sacs” were redesigned in the 1970s to contain a thinner gel ensconced by a thinner covering. It was these early implants that triggered the early 1990s litigation against their manufacturers—and which highlighted the deficiencies of the prosthetics. The U.S. Food & Drug Administration (FDA) banned silicone implants for cosmetic procedures in 1992, with the restrictions lifted in November 2006. During this 14-year hiatus, saline implants became the mainstay for augmentation procedures. Today, say most doctors, saline implants remain popular, the main reasons being cost, incision size, potential scarring and, for some patients, residual concerns about silicone safety.

It’s because of this unaltered look of the breast that in some cases it’s becoming harder and harder to tell natural breasts from those that have been surgically enhanced, a selling point for many prospective patients. That similarity is further heightened by today’s trend toward patients being more conservative when it comes to size. “Five years ago, the patients wanted to be more obvious,” says Dr. Erik Nuveen, a busy Oklahoma City-based cosmetic surgeon. “They wanted to stop traffic. But the attitude has shifted…in our practice, I’m seeing a resurgence of a more conservative approach.” Of course, when it comes to breast implants, the concept of conservative is relative, even depending on where in the country you happen to live. In Oklahoma, says Dr. Nuveen, patients generally take the “bigger is better” approach. “When a person comes in here and says they want a C cup, the question is whether they want an Oklahoma C or a Seattle C. Here, the average size is 425ccs or 450ccs. I’m keenly aware of the cultural differences that are present in the different areas.”

“It’s a big red flag if a woman comes into the office in the company of a man who tells her what she wants,” says Dr. Jane Petro

Dr. Nuveen says that plastic surgery in the central U.S. is considered routine, whereas in the northeast, for example, it’s still considered somewhat private. “When you come to the south central part of the country, women will freely tell you that Aunt Betty had a facelift at 47, grandma had hers at 72, and this friend or that friend had implants,” he says. “When I work in, say, Connecticut, for example, you find that patients are more reluctant to discuss it with their families.” Why this is, however, is hard to pinpoint. Based on breast size and sheer number of procedures, breast implants appear to be almost preferable to natural breasts in the central part of the U.S.—even more so than in Southern California, home to Hollywood, its throngs of celebrities and wannabes, and such television shows as Nip/Tuck and Dr. 90210. Even so, says Dr. Ron Moser, a cosmetic surgeon based in San Juan Capistrano, CA, this area of the country is more into liposuction and facial cosmetic surgery than breast implants – whatever the size.

These speculations are based on anecdotal evidence, of course. But Seattle-based cosmetic surgeon Dr. Antonio Mangubat says the average size his patients opt for is 350ccs, substantially smaller than in the Midwest. “There’s a fairly wide spectrum of normal, and how they [the patients] see themselves is critical,” says Mangubat. “What’s interesting is that they never see themselves as wanting more, and I would have to say that at least 50 percent of my patients believe they should have gone bigger.” Some studies show that the number one complaint postoperatively is about size, or the lack thereof, one reason why the pre-operative sizing process is so important when consulting your physician.

Why do women get breast implants anyway? The answer is typically fairly obvious: to get larger breasts. Another, deeper answer might be to live up to society’s ideal—for better or for worse—as to what a woman should look like. And that is nothing new. You need only go back to the ‘Roaring Twenties’ to see how society shapes our view of feminine beauty—in that case, to the popular ‘flapper’ look, in which a short-haired, flat-chested appearance was the chic female style. In today’s world, where buxom is considered better, the question is whether the popularity of breast implants has changed our view of beauty, or whether our changing view of beauty has made the procedure popular. Regardless, says Dr. Dryden, “All levels of society are interested in breast augmentation. With implants, [female patients] feel more womanly, more feminine…they might enjoy sex more because they feel more like a woman. This surgery has a tremendous emotional impact on patients.”

No group feels that emotional impact quite as strongly as those who have lost a breast to cancer, says Dr. Petro, who notes that women who undergo mastectomies select breast reconstruction surgery at her practice some 90 percent of the time. “Having the [augmentation] surgery plays a big part in restoring their emotional and physical health,” she says. Dr. Petro rejects the idea that women get implants to attract a mate, either male or female. She believes, as do most doctors, that patients undergo breast surgery purely so they may feel better about themselves—and that those who express reasons otherwise are not well suited for the procedure. “If she is doing it purely for her male partner, it’s a disaster in the making,” she says. “I have found that these types of control issues can backfire [on the woman].”

It still begs the question, though: do men prefer women with augmented breasts? “I think men prefer larger breasts, period. It’s instinctual,” says Dr. Dryden. “A lot of men don’t even know when women have had implants in the first place. They just see larger breasts.” Dr. Moser agrees. “Men usually like large breasts,” he says. “If implants make breasts larger, does that mean men prefer implants? No…they prefer larger breasts. If the surgery is done correctly, there’s not much of a difference in the look and feel between an implant and a natural breast.”

Dr. Moser argues that, purely from the visual point of view, implants also make a woman appear more womanly. “It harkens back to the animal kingdom,” he says. “Lions with darker, fuller manes are more successful in mating. Think about a peacock with its feathers.” But do big breasts automatically equal beauty? For a large part of our society, the answer is yes, though the attraction to them and the desire to have them might be instinctual rather than fully conscious. Several studies on beauty have shown that the desire to be beautiful, especially sexually beautiful, is a reproductive instinct, not cultural. This was the premise of the best selling (and controversial at the time) book “The Naked Ape,” by zoologist Desmond Morris, who posited that breasts served no other purpose than to make women attractive for frontal mating, once we stood up on two feet and left the derrière behind.

On the other hand, while cultural icons like Pamela Anderson and Dolly Parton grab attention, many of the women of film, television and print who are considered beautiful—Jessica Alba, Kate Moss, Keira Knightly, to name a few—are far from large breasted. From this point of view, the lithe, athletic look of tennis star Ana Maria Sharapova or racecar driver Danica Patrick has supplanted the idea of the voluptuous, rounded woman epitomized by Jane Mansfield and Marilyn Monroe in the. In this case the argument for subconscious choice of a good mate goes in favor of the lean and mean. In the end, the most important consideration is probably balance.

Regardless of size, many men—at least the men interviewed for this story—say they prefer natural breasts to implants, though this may have to do with their experience of implant technology. Older men, more typically, recall only the less supple implants of yesteryear. “My wife had implants recently and they were great, soft and natural feeling,” says Peter Anderson, a media buyer based in Los Angeles. “I love them.” And then we have the classic line in Steve Martin’s 1991 move L.A. Story, in which he climbs into bed with Sarah Jessica Parker. “Your breasts feel so strange,” he says from under the covers. “Oh, that’s because they’re real,” she replies.

Of course, it all cycles back to personal preference. “I’ve seen everything,” says Dr. Mangubat. “There are some men who love augmented breasts, and then there are the guys who try to talk their wives or girlfriends out of the surgery. As the surgeon, it’s my job to back off and say, who is this for? It has to be for the right reason.”

Indeed, says Dr. Nuveen, “There are men who say the way a woman’s body looks is irrelevant to love. But if she feels it’s an important addition to her life, then he will be supportive—regardless of his aesthetic preference.” On the other hand, says Dr. Nuveen, sometimes the surgery causes a considerable amount of insecurity for the patient’s partner.

“The men are definitely impacted as well,” he says. “When a woman seeks to change herself, we say, ‘Is she changing because she doesn’t like me? Or to attract someone else? Why would she do this when I love and support her the way she is?’ Men certainly question the decision to get implants, which adds another element of pressure.”

Petro, for her part, says that a man’s opinion on whether implants are preferable is never a reason to opt for or against the surgery. But society’s current level of acceptance, and the idea that cosmetic surgery is normative rather than aberrant, does make the decision to undergo a breast augmentation a little bit easier. “A huge percentage of society in 1970 or 1980 would have viewed a woman’s breast surgery as unnecessary,” she says. “That’s not the case anymore.” Breast augmentation is here to stay.

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