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Breast Implants: Taking Risky Road to Higher Self-Esteem

Like every aerobics instructor I have known, she had what seemed to be a “great” body. It moved fast--too fast for many in the aerobics class--and its muscles were taut. There was no excess fat.

But the owner of this body--in her early 40s if I had to guess--wasn’t entirely pleased with the merchandise. She announced to the class that she would be gone for a while.

She was having her breasts surgically enlarged.

This was late last year. I remember feeling uneasy, and somewhat embarrassed, when I heard. Certainly if I were to have such a procedure, I wouldn’t announce it to a group of strangers, most of who didn’t even know my name.

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I wondered, too, about this woman’s self-esteem. Larger breasts, presumably, would enhance it. I could understand this--I’d heard it time and again--yet it still made me sad. Women are forever striving to live up to some elusive feminine ideal.

So the aerobics instructor was just getting with the program. More than 2 million American women, most of them simply seeking bigger breasts, have gone under the knife. Tucking sacks of silicone inside women’s chests is the most common cosmetic surgery around. Even Jane Fonda is reportedly one of “them.”

But there is something else disconcerting, in a more immediate sense, about this news.

Implants have ruptured and migrated in the body, silicone has leaked, breasts have hardened. Many women and their physicians blame the implants--available for almost 30 years but never approved by the FDA--for a host of potentially life-threatening illnesses.

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Product liability lawsuits have been filed--and won; victim support groups have formed. Earlier this year, the manufacturer of polyurethane foam-coated implants voluntarily withdrew them after research showed the foam produces a chemical linked to liver cancer in laboratory animals.

Which leads us to now.

After three days of hearings, an advisory panel to the FDA announced last week that it would recommend that silicone breast implants remain on the market while research continues to determine whether they are safe. That, the panel said, has never been scientifically proved. The agency is expected to make its decision early next year.

Yet this is an issue that will not easily go away, and one difficult to relegate to the scientific realm of black and white. Passion, intertwined with differing ideas about feminine beauty and self-worth, infuses it on all sides. Political activists are being born.

“This is about choice,” says Lois Johnson, 55 years old, a Tustin homemaker and mother of three.

Johnson had breast cancer. She says her reconstructed breast, after two uncomfortable years of wearing a prosthesis slipped inside her bra, has restored her old happy self. Now she carries her “before” and “after” breast photographs in her purse.

“A woman’s breast is a part of her whole sexual body,” Johnson says. “When we amputate that, we amputate a part of our soul in some ways.”

Johnson’s plastic surgeon flew her to Washington last month to lobby legislators about the good that breast implants have done for women such as her. In all, some 600 cosmetic and cancer patients and their plastic surgeons were there for the “fly-in” that preceded the FDA hearings.

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“At one point, I said to myself, ‘What am I doing back here?’ ” Johnson says. “But then I realized I’m here for the women who will come after me. I’m here for my daughters. They are high risk. What happens if they get lumps?”

The American Society of Plastic and Reconstructive Surgeons has taken out big newspaper advertisements expressing similar sentiments; implant manufacturers have too. Both were worried that the FDA advisory panel would recommend stopping all sales. They are still worried about what the full agency might do.

I wouldn’t be writing about breast implants if I hadn’t seen those ads. The sacks of silicone had rarely crossed my mind. And certainly it is not up to me to “approve” of what another woman might do to her chest. The pain of breast cancer victims, especially, brings this home.

My own grandmother died of breast cancer at the age of 59. She never had implants. I can only hope, perhaps unreasonably, that this didn’t make her agony any worse.

But the paid hype over silicone breast implants has offended me. The ads imply that having perfect breasts is a woman’s right, a cause to rally around, something that should be a feminist cause celebre . Equal pay for equal work--and big breasts too!

“Building self-esteem is a personal issue,” one woman was quoted in a half-page ad from Los Angeles-area plastic surgeons. “As an adult, I want to be able to make my own choice.”

To me, this woman appears to have been duped.

I told Lois Johnson as much when we talked the other day. She said she could understand “where I was coming from,” and that even she felt a little uncomfortable being grouped together with women who chose implants for purely cosmetic reasons, something that she would never do.

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“In Washington, they told us, ‘Remember, you’re representing your augmentation sisters too!’ ” Johnson says.

(Now, however, she says she better understands, and sympathizes, with cosmetic patients’ point of view.)

The implant around which Johnson’s left breast was reconstructed a year ago is the same that has been taken off the market, yet it is not the possibility of adverse health effects that bother her now. Her experience, she says, has been nothing but good. And any surgery, Johnson points out, involves risk.

“They have taken the only really good one off the market,” she says. “I think it’s so sad that they had to win that lawsuit and scare the company out of business. Had I known, I would have asked my surgeon to save one for me in case I had a recurrence (in my other breast).”

Lois Johnson, a self-described feminist, says the availability of silicone breast implants is a women’s issue. She says the safety of no other silicone implants--such as one used in joints or in male “private parts"--is in dispute. She hints at a conspiracy; she makes it sound very dark.

I am a feminist too, but I don’t see how that matters here. Safety does not have a political bent. The FDA is not out to determine whether a woman’s breast size can be measured as politically correct.

The Dalkon Shield IUD worked wonderfully for many women for many years. And remember DES? The artificial Jarvik heart was hailed as a medical breakthrough at the time. There were serious problems with them all, after they were on the market, after people got hurt.

It is, sadly, the way the process works.


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