Whose breasts, anyway?
You Can't Keep Breast Implants down. Last year some 230,000 women shelled out upwards of $5,000 of their own money to have round or teardrop-shaped silicone bags filled with saline surgically inserted behind their natural breasts. An additional 70,000 women had implants after mastectomy for cancer. These numbers have been rising steadily in part because of studies that have boosted public confidence in implants' safety. Even the disgraced but more lifelike silicone version, which was banned by the Food and Drug Administration for safety concerns, may be making a comeback later this year after a decade in purgatory.
Fears about silicone gel implants--that they turn breasts into toxic, ticking time bombs ready to cause life-threatening autoimmune diseases like lupus or rheumatoid arthritis--had little scientific basis when the FDA took implants from the market in 1992. That action had women stampeding to have their perfectly normal implants removed and replaced with a less appealing saline kind. It also led to a heyday of court battles driven by junk science. Medical research quelled most of this frenzy. In 1999, the Institute of Medicine exhaustively reviewed the field and concluded that there was simply no evidence that implants caused serious illnesses such as cancer and neurologic or autoimmune connective tissue diseases. Similar evaluations have kept both types of implant on the market in virtually every other country in the world.
The controversy is heating up once again as silicone gel implants appear ready to return. In anticipation of FDA hearings later this year, the National Organization for Women held its own in late July, examining the potential risks of implants. Some speakers argued that perhaps all implants should be banned. These rumblings hark back to the silicone wars of yesteryear. The good news is that in Round 2 there is considerably more scientific information and women themselves are better equipped to weigh in on the debate. As they should: The choice of breast implants is deeply private, personal, and nonquantifiable, yet it bears a visible and mostly definable price beyond money.
To be sure, implants are not normal. They do not last forever, and they carry unique complications. They are large foreign structures that the body predictably walls off in fibrous scar tissue. Some women build up a lot of this tough tissue: The medical jargon is "capsular contracture," which translates into rock-hard breasts. That's a major reason that fully 1 in 4 women undergoes a reoperation within five years of implantation. Implants can also pop, deflate, and spew their contents into surrounding tissue. The bigger and older the implant, the greater the risk. When the liquid is saline, it's no big deal. But when it is an oozing, pasty yellow gel, it creates a big mess that needs a surgeon to go in and mop up. Other complaints include pain, loss of nipple sensation, and difficulty breast-feeding. After a few years of body beautiful, a goodly number of women just get tired of having those touchy, fragile aliens on their chest and have them removed. Unforeseen health issues may yet emerge among women who have had implants for 10 or more years. Research is weak but underway. Those contemplating the use of either saline or silicone gel implants must do so with their eyes open.
The girl next door. So who's stepping up for breast surgery, and why? You may be surprised. The typical implant consumer is not the Hollywood elite or the Las Vegas showgirl but rather is 30-something, married with a few kids, and has a family income under $70,000. And the rising number of procedures mirrors an increase in other kinds of body sculpting as well--liposuction, tummy tucks, face-lifts. (Somehow, the cosmetic surgery industry thrives whatever the state of the economy.) Indeed, ABC's new reality show, Extreme Makeover, is about the girl next door having glamorous body transformations--perhaps a perm, facial, nose, and breasts all at once--before the viewing public. Whether viewed as circus or silliness, Extreme Makeover speaks to an underlying psychosocial reality. All other things being equal, both evolution and culture have favored the big-breasted woman with clear skin and lush hair. And now medical as well as cosmetic technologies can get you there, depending on how much it's worth to you.
For some women an extra cup size or a rebuilt breast after cancer brings an important psychosocial lift. Let's allow that choice--provided it's a fully informed one.
This story appears in the August 11, 2003 print edition of U.S. News & World Report.