IDHOSPITAL

Our breasts are our womanhood, or so many of us believe. There is no other body part treated the same way as the female breast. It’s beauty and sex and food and fertility and motherhood and femininity and intimacy and so on.

In her book Breasts: A Natural and Unnatural History Florence Williams states that we “burden our breasts with our expectations”. Or alternatively, perhaps they could be symbols of power that hold great influence over our culture and over ourselves.

Regardless of how we think about our breasts, the likelihood of us developing breast cancer at some point in our lives is 13% in the United States, 9% in Europe and ranges from 2% to 12% in East Asia Pacific, meaning that some of us will be heading down the road of breast surgery regardless of how we feel about our bodies. Where to begin?

 

 

Throughout history female breasts have often represented similar aspects of the human experience, and have led women into both power and prejudice. The most obvious cultural use of breasts in this way is the folklorish link between female breasts and consumption – literally with breastfeeding infants, but also metaphorically with adjectives such as “delicious” or “sumptuous” used to describe female bodies. This is discussed in an article from EATER where Claire Carusillo says “Together, and for thousands of years, human ritual, language and biology have worked to position women not as people, but as vessels to sustain – and invigorate – male lives”.

But with the societal and cultural changes of the last 150 years, our bodies and our breasts have been returned to us, at least in theory. And now that we own our own bodies and earn our own money, we should be able to do with our breasts what we damn well please.

 

The First Breast Augmentations

The desire to change breasts either in size, shape or position goes back long before the invention of modern surgical techniques, or the invention of modern anything.

The history of fashion shows us that, particularly in Western canon, we have been contorting our breasts into the latest fashionable shape for hundreds of years. We’ve gone from vaguely tying a piece of cloth around ourselves, to ancient Roman “athletics bikinis”, to Middle Ages shirts with bags, to the classic corsets, bodices, camisoles, pointed bras, bullet bras, underwired bras and now with the surge in popularity of bralettes it seems we’ve arrived at the bikini-style again.

The first actual modern medical attempts to shape or enlarge the breasts began in the 1890s. Surgeon Vincenz Czerny is credited with performing the first breast augmentation / breast reconstruction in Germany in 1895. Sadly, while Czerny was to become known as the “Father of Plastic Surgery”, his patient’s name has been lost to history. She was a singer in her forties who had just undergone the removal of a tumour in one of her breasts. Understandably, she was upset by the uneven appearance of her breasts after the operation. Dr. Czerny found that she had a rather large, fist-sized lipoma, although sources differ as to exactly where it was on her body. A lipoma is a benign growth made of fat cells, which are not too dissimilar to the contents of a human breast. Dr. Czerny carefully removed the lipoma and inserted it into the breast cavity, creating a more symmetrical shape.

While Czerny’s technique was innovative for its time, it was clearly not a repeatable method of breast augmentation. Not every woman has a convenient lipoma they can hang onto for just such an eventuality. But using the patient’s own fat is still one method of breast enhancement that is used to this day.

But before the autologous fat-grafting method of breast augmentation would be invented, surgeons up and down industrialised nations would try to inject everything else into breasts first.

The range of substances inserted into breasts during this time includes synthetic wool, medical sponge, dental filling material, paraffin, liquid rubber, various plastics, animal cartilage, ivory and glass balls. Unsurprisingly, these trial-and-error augmentation attempts would often ruin the lives of the women operated on. Complications included liver problems, pulmonary embolisms (blood clot in the lungs), infections, skin necrosis, comas and death

Paraffin injections were reportedly used in Korea during the late 50s and 60s, resulting in tissue necrosis, ulceration, fistulae and abscesses. Silicone injections were all the rage for a while, particularly in Japan, until it was clear that they caused disfiguring granulomas, tissue hardening and gangrene.

 

 

There was a non-life ruining method that was innovated during this time, that being the rotational flap method. Where part of the patient’s own tissue was rotated under the breast to give the impression of more voluminous breasts. But the real innovation came in 1961 when American surgeons Frank Gerow and Thomas Cronin developed the first modern breast implant made from a teardrop shaped rubber-silicone shell containing viscous silicone liquid.

 

Development of the silicone implant

The first recipient of their invention was a dog named Esmerelda. There were no harmful effects of the implant on the dog, although reportedly, it had to be removed when Esmerelda began chewing her stitches. The next year Gerow and Cronin’s implant had its first human recipient Timmie Jean Lindsey. She had only come to the doctors’ clinic to get a tattoo removed from her breast, but through what must be superhuman powers of persuasion she was convinced to become the first ever silicone breast implant patient. The deal was that if she would agree to the implant surgery she could also get a surgery to pin her ears back.

Thankfully, in a post-surgery interview with the BBC, Timmie Jean described her new augmented breasts as beautiful. She remained satisfied with her implants for the next fifty years, although she was reporting some symptoms due to having had the same implants for the entire fifty-year period. Modern breast implants have to be replaced every 10 to 15 years.

Developments in silicone implant technology have mostly been centred around three aspects: Improving naturalness, reducing rupture and reducing adverse outcomes such as capsular contraction and silicone leakage. Although the type of breast implants that are available to you still differs largely by region. For example, silicone-filled implants covered with polyurethane were discontinued in the US in the 1990s due to a scare that the special coating, designed to reduce rates of capsular contracture, could break down into the carcinogenic substance 2,4-TDA. After investigation, the US FDA found that the possibility of getting cancer from breast implant 2,4-TDA was infinitesimally small, but the implants are still no longer used in America. To this day they are available in Europe and South America. But this isn’t the only role played by the FDA in this story.

 

FDA ban and rise of saline implants

From the 1970s to the 1980s women were filing, and winning, lawsuits about pain and suffering they had endured due to ruptured silicone breast implants. This caused the US FDA to re-categorise them as a Class III Medical Device, meaning the manufacturers would have to present data confirming the implants were safe. When the manufacturers were still unable to provide this data by 1991, the implants were taken off the market for use in cosmetic surgery – now only being available for certain breast reconstruction cases. This meant that until 2006 silicone implants were unavailable in the USA which is the world’s largest cosmetic surgery market. Ready and waiting to replace them were saline implants.

 

 

Unlike what you may think, saline implants were not created in response to the FDA ban, but were invented just after silicone implants in 1964. They were made from a similar shell to the silicone implant, but without the silicone gel filling. This meant that if they ruptured, which they did at a higher rate than silicone, then only harmless saline liquid would be released into the body. The higher failure rate was one downside among a few. Depending on how little existing breast tissue the patient had, the saline implant could be more noticeable through both look and touch. And they had a higher instance of “rippling” – an unnatural wave-like formation on the sides of the breast which is most visible when a patient leans over.

However, they may still be the best choice for some people. Because saline implants can be filled after they are inserted into the body, they leave smaller scars, they can look very natural when implanted under the muscle in a woman with a fair amount of existing breast tissue and some women feel safer knowing that a saline rupture wouldn’t cause harm to their bodies.

 

 

In 2006 the US FDA gradually began letting silicone implants back onto the market after the risk of silicone leakage on patient health was not deemed serious enough to continue the ban. It was judged that patients can be sufficiently informed to be able to make their own decision about implant type.

Meanwhile in Europe, where silicone implants were available for cosmetic surgery almost everywhere, “next gen” or “fifth gen” silicone implants were approved for use. These implants were to gain fame in the following years as the “gummy bear implant”. Gummy bear implants were named after their cohesive silicone gel filling, which can maintain its shape even if the shell is broken, unlike traditional silicone gel. Apparently one surgeon believed this trait gave the implant a similar consistency to a gummy bear. These implants are tapered at one end for a more natural appearance and usually have a textured surface. The cohesive silicone filling means any rupture releases less silicone into the body and a failed implant is easier to remove.

However, the FDA did manage to save many Americans from one particular type of dangerous breast implant.

 

The PIP Scandal

Jean-Claude Mas established Poly Implant Prothèse (PIP) in France in 1991 and began the manufacture and sale of saline and silicone breast implants soon after. France had followed the USA in banning silicone implants, so during the company’s first few years they exported them, many of which went to the United Kingdom.

In 2000 two things happened. France lifted its ban on silicone implants and the UK bans PIP implants stating the product’s safety assessment was insufficient. However, by 2010 it has been revealed that PIP had been using industrial-grade silicone instead of medical-grade in their breast implants. When the French government offers free implant-removal surgery to the victims, the number of French women with PIP implants has already reached 30,000.

French courts award damages but to the French victims only.

PIP files for bankruptcy.

Jean-Claude Mas is sent to prison for four years.

Fake Breasts

Features that have been altered with plastic surgery are often referred to in our culture as “fake”. But not all of the time. It would be rare to see this comment directed at, for example, someone in an industrial accident who has cranio-facial surgery, a transgender person undergoing gender-affirming surgery, someone who has breast augmentation without implants or a woman who has breast implants inserted after fighting cancer.

Fake implies a judgement of the features and of the person themselves, that they are shallow, vein, self-obsessed, in a way that is rarely applied to other forms of body modification. Considering how important human breasts are to the life-cycle itself, it’s a rude way to talk about them. Considering how culturally important they are, it’s no wonder that breast augmentation is the second most common type of plastic surgery in the world.

As women have tentatively climbed into positions of artistic authorship and societal examination, we have more of an opportunity to define how our bodies, and actions, are depicted. Who decides what a “real” breast is anyway?

Below is a selection of artworks concerning the breasts and the body by French artist Louise Bourgeois.

 

 

In this unique juncture in the history of our sex, what do you think about breast augmentation? Have you had breast augmentation? Do you want it?

Perhaps we should all be thinking more about these culturally important yet divisive things attached to our chests.