ROBIN ABCARIAN : Get the Facts, Ma’am, Then Make Choice
We want to be protected, yet we want to control our own lives.
That fundamental clash is now playing out in the horrifying saga of the subversive breast implant. The drama is all the more deeply felt because at its center is the most symbolic part of the female anatomy, the part that represents a woman’s second-best shot at death by cancer, the part that is the quintessence of her sexual vanity.
As the implant debate rages, pundits bemoan the superficiality of a world where identities are so bound to physical attributes. But when has that not been the case? When have we not been slaves to how we look? And what does that say about controlling our lives?
It’s not so terrible that women avail themselves of what medical science offers. In fact, it’s magical that we can flaunt heredity--change our breasts, our noses, our flabby midriffs.
What is terrible, or at least troublesome, is that we judge our success as women against how we look, the manageability of our hair, the firmness of our thighs.
Even worse is the way the standard mutates. After all, the ideal against which we tally our parts is a mirage, an ever-changing silhouette that is big and pointed today, small and rounded next year. Think of the flat-chested flappers of the ‘20s, the projectile bosoms of the ‘50s, the boyish bust lines of the ‘60s.
How many fashion stories in recent years have touted the “new, athletic” aesthetic? The meaty Cindy Crawford vs. the anorexic Twiggy. You may not have noticed, but a couple of years ago a gaggle of the world’s top fashion models went from barely there to busty. Clearly, we live in a world where there are emotional and literal payoffs for matching the ideal.
It is a strong and unusual woman who can steel herself against the prevailing winds of style, whether they blow for something as major as bigger breasts or as minor as washing away the gray. The woman who opts to battle Mother Nature need not compound her anxiety with guilt.
They call breast augmentation “cosmetic” surgery; for 80% of women, it is a matter of desire, not necessity. But the operation is far more profound a step than the word cosmetic implies.
Women I know who have bought bigger breasts have done it to satisfy deep longings, to fill out their clothes, to feel sexier. I know one woman--and Hollywood is filled with others like her--who did it for her modeling career. I have never heard a woman say she risked such major surgery to snag a husband or save a marriage, but who can doubt this happens?
With the emotional and physical stakes so high, it is appalling that women with implants have had to wait so long for the Federal Drug Administration to raise safety questions, for manufacturers to say what they know.
The jury is still out on whether there are links between illness and silicone gel. But Thursday, the FDA advisory panel studying implant safety recommended they be allowed only for reconstructive surgery. Women who simply want to be bustier would have limited access to implants, and then only if they are part of scientific studies.
But what will happen if the FDA-supervised studies eventually confirm our fears and determine that women with silicone breasts may indeed risk developing autoimmune disorders or cancer? What will happen if the risk is small but documentable? Who will decide who may have the surgery?
Who, ultimately, should judge the scales a woman uses to balance future physical health against present emotional health?
Sonia Brody, a Westwood psychologist who started a support group last month for women with implants, thinks the FDA may indeed ban silicone implants completely. If it does, she says, women will be deprived of a choice that is rightfully theirs.
“My mother cannot take aspirin,” Brody says. “Am I going to say aspirin is bad for everybody? It is a matter of choice.”
Brody says if the FDA bans implants, demand will not disappear, but safety might. “This issue of breasts for women is not going to go away,” she says. “Ban it, and you will have women going to Mexico and South America getting botched jobs. Believe me, we have the best surgical techniques in the United States and it will be a crime if women have to go elsewhere.”
Back-alley breast implants? Maybe. Brody says women should not have to face that possibility: “As long as I am informed and have the facts in front of me, I should be able to make the decision.”
FDA Commissioner David Kessler is expected to rule on silicone gel implants by April 20. By then, he will have decided whether access to implants will be unrestricted while clinical studies are conducted by manufacturers, or whether access will be restricted during the study period as his advisory panel has recommended.
Suppose he lifts the voluntary moratorium and allows implants to stay on the market with the caveat that patients be warned of potential hazards. What if a woman, informed of the possible complications, opts for implants anyway, and later develops painful swelling in her joints, enlarged lymph nodes, lupus or any of the other scourges potentially linked to silicone implants? Should subsequent treatment, such as removal, be covered by her insurance? Or should her insurance company be able to deny her claim, because the original surgery was voluntary and she signed off on the risks?
Such a scenario is not unheard of. Sharon Green, executive director of the Y-ME National Organization for Breast Cancer Information and Support, wrote recently that millions of women have opted to use birth control pills, fully aware of risks that include blood clots, heart attacks, strokes, gall bladder disease, liver tumors, mood changes, dizziness and nausea.
The debate over silicone implant safety should have occurred years ago, long before 2 million devices were implanted. Too late for that. But not too late to remind ourselves that a woman has the right to be in charge of her own life, her own health.
Give her the facts-- all of them. Then let her judge.
