A Complex Decision

By Kristen Tsetsi
Journal Inquirer
Published: Thursday, October 2, 2008 12:48 PM EDT

"Hooterville" used to be the wholesome pastoral town depicted in the 1965-71 TV series Green Acres. Among Hooterville’s citizens were quirky farmers holding bent pitchforks and general store owners who were also the town postmaster, justice of the peace, and publisher of the local newspaper.

Not these days. “Hooterville” is now considered a physical state to aspire to by a select sect of the American female culture, and, as an abstract sort of “village,” it comprises nearly 2.5 million women who have opted to get breast implants.

The lightness of the name “Hooterville” belies what can often be a psychologically complex, and sometimes physically damaging, decision.

Breasts, it would seem at the surface, are an accessory at the whim of changing fads. Either that or nature has sorely failed women, who have ultimately decided: “If you want something done right, do it yourself.”

The American Society for Aesthetic Plastic Surgery’s “ask-a-surgeon” page says that breast augmentation is “a proven way to improve the size and shape of your breasts.”

But this poses a question or two, such as, what does it mean to “improve” the size and shape of a breast? Who’s deciding what the “correct” size or shape is? And when did a regular breast first start to need “fixing,” anyway?

It seems it was at least as early as the late 1800s, when Rubenesque curves were “in” and surgeons would inject a woman’s own fatty tissue into her breasts to give her the desired ampleness to suit the times. After that, women tried everything from glass balls to ox cartilage to change their breast shape and size.

In the flapper era of the 1920s, thinness and small breasts were at the height of popularity and women would bind their breasts to make themselves appear flat-chested. But later, in the 1940s and ’50s, big breasts made a comeback and another differently barbaric procedure involved rotating the patient’s chest wall tissue into the breast to add volume.

Reasons behind augmentation

Why so many women are eager to surgically alter their breasts is a question asked even by one plastic surgeon.

“When I have a young woman — unmarried, early 20s — come in and she has a beautiful body, B cup, and says she wants a C, I want to know why,” says Dr. Stephen Brown, a Hartford plastic surgeon who has performed thousands of breast implant surgeries at an average of 100 per year.

If you ask the American Society of Plastic Surgeons, the benefits of breast augmentation surpass simple physical “improvement.” Its Web site, Plasticsurgery.org, boasts that “plastic surgery — whether cosmetic or reconstructive — encourages and promotes a strong, positive self-image.”

It goes on to say, “Even a small change on the outside can create an extraordinary change on the inside, allowing an individual’s self-confidence to flourish.”

Brown, who’s taught in the field for 30 years, says that while he’s a member of that society and others, he doesn’t agree 100 percent with the sentiment.

“Self-esteem should come from within,” he says. “Can plastic surgery improve you a little? Yes, if you’re also working on it from within. Any surgery we do can kind of give them a lift, but it’s not going to really change their life. It’s not going to be a life-altering alteration.”

Still, the promise of better self-esteem, which is not proven and has in fact been argued by the American Psychiatric Association, is working.

In 2007 alone, the number of women who had breast augmentation surgery was 399,440, according to the American Society of Aesthetic Plastic Surgery. That’s a nearly 82 percent increase over the 220,000 women who received the surgery in 2001.

Help with free implants

There’s even an Internet site designed to help women get free breast implants. At MyFreeImplants.com, a Web site co-founded in 2005 by California resident Jason Moore, testimonials grace a full Web page.

“Hey guys and gals! I have returned home to find myself in Hooterville!!!!!” writes one young woman after discovering her new breasts were paid for.

At MyFreeImplants.com, women — whom Moore says are mostly in their late 20s who have had children and want to “repair” their bodies — post their pictures online and become part of an online community in which they vie for the attention of male “benefactors.” Benefactors buy “message credits” for as low as $1.20 that are used to send messages to the women. Each message sent earns credit toward the woman’s procedure.

In February, 83 women raised enough money for implants. As of early April, that number had reached 120.

“We had 21 success stories in the month of January, and 19 in March,” Moore said in a telephone interview. “The highest age of a successful woman was 54.”

“Success stories” are women on the site who receive fully-funded implants.

In February, benefactors numbered 20,000. Now there are up to 40,000, Moore said.

The breast industry is clearly a successful one. Before creating MyFreeImplants.com, Moore, who has an MBA in marketing, had tried starting two other Web-based businesses — one in e-mail security and one in computer hardware. Both failed.

“There are a lot of men really into breasts, so it’s very successful,” Moore said.

Complications abound

The list of 25 implant-related complications compiled by the federal Food and Drug Administration, most of which would require non-surgical treatments or re-operations and possibly removal of the implants, isn’t much of a deterrent to breast buyers.

The list includes breast pain, asymmetry, toxic shock syndrome, wrinkling or rippling, hardening of tissue, and chest wall deformity.

Brown says the most common complication is contracture, the hardening of the scar tissue that holds the implant in place.


“It tightens or shrinks, and it squeezes the implant and makes it feel harder,” Brown says, noting that contracture occurs in between 5 and 10 percent of saline implants, but with the older gel implants, it would occur in as high as 50 percent of the cases.

Another complication he sees a lot of — “It’s more common than I’d like to see,” Brown says — is malformation of the breast after implants are inserted under the muscle, a technique he says too many young people see online and think is the best way to go. Sometimes it is, he says, but sometimes it isn’t.

When it isn’t, “the implant stays high under the muscle, but the tissue descends with age, so you have this weird vertical up-and-down. Particularly if you had implants done before you had children, or had them done after pregnancy and then had another child,” Brown says.

And then there are the really serious complications.

National Cancer Institute studies found that compared to other plastic surgery patients of similar age, women with breast implants were twice as likely to die from brain cancer, three times as likely to die from lung cancer or other diseases, and four times as likely to commit suicide, according to a report contributed by the Implant Information Project of the National Research Center for Women & Families.

Why suicide?

The American Psychiatric Association’s online magazine “Monitor on Psychology” explains that researchers speculate that some surgery recipients may have unrealistic expectations of the surgery’s results, or have certain personality characteristics that predispose them to suicide.

“If someone’s got a really nice figure, what are they looking for” in breast implants? Brown says. “Why do they want to put something foreign in their body? If it were my daughter, I would discourage her. I would say, ‘What’s going on? What’s wrong?’”

Self-esteem issue debated

As for the American Society of Plastic Surgeons’ claim that plastic surgery boosts self-esteem, the magazine article notes that there are no firm results indicating plastic surgery boosts self-esteem, improves quality of life, or heightens self-confidence in the long term.

Brown says the only patient to ever come to him for implant removal was 40 years old, and that her reason was that she didn’t “need them anymore.”

“That was her quote,” Brown says. “I think it was really a matter that when she was younger, she felt more insecure about herself.”

The nice thing about implants, Brown adds, is that they’re completely reversible. Once an implant is removed, the skin and breast tissue will usually return to the original shape. Unless a woman gets implants that are too large, he clarifies. If the implant is too large, the skin and tissue will stretch too far.

The implant will also be uncomfortable if too large, he says.

“I won’t give anyone a D cup,” he says. “It won’t be comfortable. Most women with natural D cups will get surgery to make their breasts smaller.”

Brown then remembers one woman he did, in fact, give a D cup. “She was 6 feet tall and had a C cup and wanted to fix her proportions.”

Brown adds that some surgeons, if offered the money, “will put in whatever the woman wants because they don’t want to lose the patient.”

He believes it’s wrong not only to provide too large of a cup size, but to give implants to women who want the surgery for what appear to be unhealthy reasons.

“There may be instability, they may be crying a little bit, they want it too much, they may feel like they’re entitled to have it done. They’re just not giving good reasons for wanting it,” he says.

Brown has turned people away and told them to come back in six months to a year.

He also calls the parent-to-daughter breast implants graduation gift, a trend that became popular several years ago, “wrong,” psychologically.

“It sends out the wrong message,” Brown says.

His ideal breast implant patient, he says, is a woman in her 30s who has had children and is happy but “wants to fill a bathing suit or feel a little sexy in a cocktail dress.”

When women just want to feel feminine, Brown says, is when breast implants make the most sense, such as after a mastectomy, or — as stated before — after children or in the case of a deformity.

But sexiness and self-confidence aren’t inherently found in a C or D cup.

“Marilyn Monroe was a B cup — not even a large B cup — and she’s one of the sexiest women that ever lived,” Brown says.

He also provides actress Debra Messing of the television series “Will and Grace” as an example of confident small-chestedness.

“She’s flat-chested, and she isn’t running out getting breast implants,” Brown says.