A Historical View

Breasts have been symbols of female power since ancient times, notes Gayle Pitman, Ph.D., a psychology and women’s studies professor who teaches a course called “Psychology of Women” at Sacramento City College. “I remember visiting art museums and seeing these ancient sculptures of multibreasted women—clearly a source of power,” she says. These fertility goddesses were part of Greek, Roman and other ancient cultures in which breasts, body fat and menstrual cycles were all symbols of female power—the ability to give and sustain life.

Fast-forward to 21st century America, and a schism begins to appear. “Women in our culture are expected to maintain a slender, idealized figure, making body fat unacceptable,” observes Pitman. Meanwhile, women still are expected to sport bountiful breasts—a combination that is unrealistic, if not unattainable, for most.
“Right now, it’s not only about having big breasts, but being ‘pumped up’ with muscles,” notes Lesley Schroeder, M.D., a psychiatrist in private practice and associate clinical professor in the department of psychiatry and behavioral sciences at UC Davis. “We’ve gone from the Twiggy waif of the ’60s to the ‘ideal’ woman of today, who is incredibly athletic and buffed with minimal body fat and big boobs. Now tell me how that works?” In other cultures, she adds, “having a rounded body and big hips means you can have children. Extra weight means you can survive the famine.” But in our fat-phobic culture, the media would sooner promote the image of “an emaciated woman with false breasts,” as Schroeder puts it.

While the sex appeal of today’s American woman is largely measured by her breast size, that’s not the case everywhere. “Of the many thousands of discrete cultures around the world, only a few view breasts as sex objects and/or involve manipulating the breasts as part of sexual behavior,” says anthropologist Katherine Dettwyler. When Dettwyler told women in the West African country of Mali that many American men play with breasts during sex, they laughed out loud.

But just go tell that to your average American female (or male), whose perception of what it takes to be a W-O-M-A-N has been defined by everyone from Marilyn Monroe to Madonna. “People have always been concerned about breast size, whether too large or too small,” says Barbara Goldberg, a licensed marriage and family therapist in Sacramento. “When I was in my 20s, the hourglass figure was in: small waist, curvy hips and breasts. Now it’s a different ‘ideal,’ but breast size is still considered important.” The difference between then and now, Goldberg says, is that it’s much easier to get cosmetic surgery.

Breast Augmentation: The Big Boom

Not only is cosmetic surgery more accessible, but it’s better than ever, notes Kenneth Phillips, M.D., a board-certified plastic surgeon for Kaiser Permanente. “There are improved techniques and minimal downtime,” says Phillips, adding that most of his breast-augmentation patients are back to work in five to seven days. “With a competent surgeon, the outcomes are good and the risks are low.” The recent proliferation of plastic surgery makeover shows such as “Dr. 90210” and “The Swan” also has encouraged more women to scurry to the surgeon.

Breast augmentation is one of the most popular cosmetic surgeries of all. It was No. 2 (right behind liposuction) in the United States in 2004, according to the American Society of Aesthetic and Plastic Surgery, and it also ranked No. 2 among cosmetic surgeries performed at UC Davis Medical Center and Kaiser Permanente’s Cosmetic Surgery Center in 2005. ASAPS noted a 19 percent rise in breast-augmentation surgeries performed nationally between 2003 and 2004.

But whether implant size also is on the rise is largely a matter of geography, according to Phillips. “I think there’s absolutely more social pressure to go ‘larger’ in certain locations, such as Los Angeles, New York and Miami,” he says. By comparison, he says, his patients tend to be more modest in their requests, with an average increase of about one cup size. “They actually come in and say, ‘I don’t want the implant look.’” Most, he says, are more interested in achieving better body proportion than they are in being “overly large.”

“I think most people in Sacramento are a little more sane,” agrees Debra Johnson, M.D., a plastic surgeon in private practice at the Plastic Surgery Center and chief of plastic surgery at Sutter Medical Center in Sacramento. “My colleagues in Southern California use really large implants, perhaps because it’s a more breast-centric society there—less clothing, more cleavage.” The few times she’s watched “Dr. 90210,” Johnson has been shocked by the size of implants the surgeons recommend. “Whoa!” she exclaims.

Still, there are signs that even “sane Sacramentans” may be turning toward titanic ta-tas—or at least bigger ones. In a review of patients who underwent breast enlargement at Sacramento’s Plastic Surgery Center, Johnson found that the average implant size nearly doubled in a 20-year period (1978–1998). “In the ’70s, the average increase for our patients was about one full cup size, but nowadays, the average is about two cup sizes,” she says. “Some of this is probably due to the fact that breasts are a little more ‘out there’ than they used to be—people are wearing more revealing clothing.”

But installing implants that are too large for a patient’s frame is a major no-no, warns Johnson. “As part of my spiel during a consultation, I tell patients what their body will allow,” she says. Breast width is particularly critical. “You want to put in an implant that is similar in width to the patient’s breast,” she explains. “If it’s too wide, it will either stretch out the breast horizontally, or it will ride too high, and then you look like the girls in Victoria’s Secret.” Skin quality is another determining factor. “Someone with nice, sturdy skin can tolerate implants better than someone who has what I call ‘eyelid’ skin,’” she says, referring to thin, fragile skin. Worse yet, there is even the risk of exposure (extrusion) of the implant through the skin—not exactly the kind of “popping out” party the patient may have had in mind.

Other risks associated with breast implants include a diminished ability to breastfeed, especially if the incision is near the nipple; sensation loss to the skin or nipple; and obscured mammography readings. But getting a larger cup size shouldn’t add to the cost of your implants, which, in the Sacra-mento area, run about $4,500-$5,500.

Who Gets Implants?

No, we don’t have the scoop on which local celebrities are the proud owners of a new pair of “twins.” But we can tell you this: It isn’t all about singles seeking sexual sizzle.

“Most of my breast-augmentation patients are married with children,” notes Johnson. For many of these women, she says, the goal is only to regain their fuller, perkier, pre-pregnancy breasts. “They’ve lost volume through pregnancy, so with the surgery you’re just giving them back what they lost.”

Maybe, as Schroeder suggests, there’s a difference between these women and the ones who aren’t satisfied with the hand genetics dealt them. “There’s a lot of people who get really tied up in competing and keeping up with the Joneses who fall into the trap of ‘If I just do this, I’ll feel better about myself,’” she says. “For me, there’s a difference between the woman seeking an unrealistic body image or to feel better about herself with a ‘quick fix’ and the woman who breastfed for six years whose breasts are nonexistent or hanging down to her navel wanting to reclaim her pre-pregnancy breasts. Is that truly cosmetic? Or is it more like reconstruction?”

For 51-year-old Sacramento resident Marian Albano, it was a little bit of both. Although she had suffered what she calls “baby damage” and primarily sought breast augmentation to lift the sagging skin that developed as she moved into her 40s, she was also lured by the boost in self-confidence and sexual “oomph” that having larger breasts could bring.

“I do feel sexier, but I felt sexy before,” says Albano, who went from an A to a large C cup during her first surgery at age 45, bumping up to a D during a second surgery several years later. (Her original implants rippled.) “I feel I look better. For an old bat, my boobs are looking pretty good.”

But she’d never try to fool anyone into thinking they were real.

“I have women come up to me at the gym and say, ‘You have the perfect body,’ and I stop right there and tell them, ‘Wait a minute. I bought it.’” And although a D cup may sound a
little large for her small, 5-foot-4 1/2-inch frame, Albano feels she now is
better proportioned and looks better in her clothes.

She did it for herself, and advises others to do the same.

“Don’t do it for the men or for anyone else—do it for yourself,” says Albano, who is engaged to the same boyfriend she had pre-surgery. “Do your homework. Try not to go into debt over it. And don’t take it too seriously! You have to keep things in the proper perspective. I try to find the humor in it.”
But not all prospective patients have Albano’s attitude—and that’s what has a lot of folks worried.

I’m 18 and I Can Do What I Want

“The ones I’m really concerned about are the teens,” says Schroeder, who draws a link between eating disorders, body dysmorphic disorder (a mental disorder characterized by a preoccupation with imagined defects in one’s appearance) and the rising trend of teens who flaunt the new breasts they got for high-school graduation. “Underlying all three of those is the same striving for perfection: a false belief that if you fix the outside, you’re going to fix the inside.” Young girls today feel “tremendous media and social pressures to conform to unattainable physical ideals,” she says. Add peer pressure to the mix, she maintains, and it’s a recipe for disaster.

“Even little 8-year-old girls are looking in the mirror, pushing their breasts together to give themselves cleavage . . . it’s very disturbing to me,” adds Goldberg. “Teenage girls are the prime example of self-esteem going up and down, up and down, and if they don’t fit in with the others, they feel really badly about themselves. This is where the negative body image sets in.”

Lauren Taylor, a 20-year-old Hooters waitress and a well-endowed 38D, is one of the lucky ones: She’s “real.” But three of her girlfriends, she says, are “fake.”

“Personally, I don’t think it [breast augmentation] is necessary,” says Taylor, who competed against 1,500 Hooters hopefuls to land one of 80 spots when the chain, famous for its shapely young servers (or is it the chicken wings?), debuted in Sacramento this past August. (There are now two locations.) “I don’t think a person’s worth is about breast size—it’s about personality and it’s about the whole person. But for a lot of my friends, getting fake boobs is about self-esteem.”

Although 18 is the minimum age for which breast implant devices have been approved by the Food and Drug Administration for cosmetic use, some wonder whether most 18-year-olds are ready to handle the surgery’s potentially far-reaching physical and psychological ramifications.  

“Some individuals may not be mature enough at that age,” admits Phillips, who estimates that 55 to 60 percent of his breast-augmentation patients are in the 18-to-25 age group. “But it then somewhat falls on the surgeon’s responsibility to determine if a particular patient is emotionally and psychologically prepared for surgery.” Phillips adds that he has had “quite a few” patients in the 18-to-20 age group, and they’ve handled the surgery well. “All of them have done exceedingly well, and I am very proud of them,” he says. “I cannot remember one of them that had any regrets, and they are very happy with their decisions.”

Johnson, for her part, believes anyone undergoing cosmetic surgery should pay for it herself, and feels particularly strongly about this “rule” as it applies to younger women.

“An 18- or 19-year-old who wants breast augmentation or liposuction or some such surgery should not have their parent pay for it, even if that parent is supportive,” she asserts. “I think taking financial responsibility forces a younger person to think longer and harder, and have more ‘ownership’ of the decision.”

Whose Breasts Are These, Anyway?

Taking ownership of a decision is one thing. But real or faux, do women really feel they own their breasts? Pitman thinks not.

“I think they see breasts as a source of something for somebody else,” she says, “as sexual pleasure for men, as nursing for infants, or objectified in the media as a means of selling products.”

America’s obsession with breasts also is dangerous in that it “somehow separates us from humanity,” says Claudia Talbert Bays, a retired registered nurse and professor of nursing at Sacramento State. “Focusing on breasts takes you away from looking at the whole, beautiful person. The augmentation trend is a cartoon in a way—it’s not even about a real person.”

While Bays believes people have a right to do what they want to do—including having cosmetic surgery—she has concerns about a culture that considers cup size a measurement of worth.

“I think we do a huge disfavor to women to make them feel they have to be big-breasted to be valuable and sexy,” she says. “You don’t need to have big breasts to be sexy.”