A Surgical Cure for a Cultural Disease


November 12, 1991|By ELLEN GOODMAN

BOSTON. — Boston -- I arrived at adolescence in the era of training bras and Angora sweaters. I never did figure out what these bras were training us for -- womanhood? the Great American Breast Fetish? -- but now I look back to that era, reluctantly, as the good old days.

Thirty years ago we gossiped about which of the girls in our class and our Seventeen magazines were wearing falsies under their blouses. Now we gossip about which of the Miss America contestants and People magazine subjects are wearing falsies under their skin.

The hourglass figure, that fantasy of the 1950s femininity has been transformed into a muscular anorexic with a C-cup in the 1990s. Since this is a model that rarely comes off of nature's shelf, it is being manufactured.

Some 2 million American women -- one in 60 -- have had their bodies cut open and implants put into their chests. Last year alone, 150,000 paid their surgeons between $3,000 and $5,000 for this piecework. Fewer than a third of the women were cancer patients undergoing reconstructive surgery. Most were trying to ''enhance'' their self-image by enlarging their breasts the new-fashioned way.

Remember in ''Chorus Line,'' when a young dancer bragged that the operating room, not the casting couch, was the secret of her success? In real life, breast implants are now a success accessory that you can buy in your nearest surgical shop. They have become the most common cosmetic surgery on the market and silicone is the most popular product in the line.

Now, the safety of silicone is going to be reviewed by an advisory panel in a three-day session. This week, the FDA is likely to air more about the risks of this procedure than many patients have ever heard.

The FDA will hear about implants that harden and implants that migrate, about infections and bleedings, ruptures and replacements, arthritis and scleroderma, numb nipples and hard-to-read mammograms. They'll hear reports that say the odds of serious trouble are very very small and reports that say they're too large. And they're likely to hear that the research on silicone implants is still skimpy.

As for the benefits? Congress has already been inundated with women worried that their breasts might be banned. A campaign by the American Society of Plastic and Reconstructive Surgeons has mobilized support to ''help all women retain the right to decide for themselves about breast implants.''

Like many in the American public, I have two sets of feelings about breast implants: one about the choices confronting cancer patients and another about cosmetic patients. But I am of one mind about public policy. There should be a single standard of safety for silicone and a single standard of choice. If implants are safe, women should be able to choose them.

But what bothers me about the buyer's market in bigger breasts is not just the danger. It's that this boffo biz is based on insecurity. It's built on a diversifying database of self-hates. Cosmetic surgery is the lucrative business of fixing an ever-expanding list of things that are ''wrong'' with women.

''What we have had in the past ten years,'' says Naomi Wolf, the author of ''The Beauty Myth,'' ''is a determined drive by the cosmetic-surgery industry to make women feel their breasts are inadequate.''

The very same plastic surgeons now urging women to protect their right to prostheses began pushing them in the 1980s. Their association's press releases described small breasts as ''deformities'' that were ''really a disease.'' The diagnosis was ''a total lack of well-being'' and the prescription was an implant. A surgical cure for a cultural disease.

Cosmetic surgeons for their part run ads that often make breast implants sound as simple as buying contact lenses. And for a time, the women's magazines joined in with feel-good-through-simple-surgery stories.

Some women do indeed feel better with implants. But there is a symbiotic relationship between a culture that makes women feel bad about their bodies and a business that makes them feel better. We know that every time we belly up to the blush-on counter. This time we are not talking about face powder.

The advisory panel may end this week without enough evidence for a ban or for a silicone seal of approval. But we'll all know more about the personal price of ''beauty.'' And the more a woman is informed, the less she may give consent to this surgical fashioning of femininity. We're not in training any longer.

Ellen Goodman is a syndicated columnist.

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