Breasts Read online

  Would she do it all again? She’s not sure.

  “I’d have to look at my options.”

  For now, she’s trying to decide whether or not to return a request from Tom Biggs to examine her. She knows her breasts are of great medical interest. “I suppose I should call him,” she said.

  “Would you donate your body to science?” I asked.

  She laughed. “No, but they can have ‘em if they want ‘em.”

  THE 1962 ENLARGEMENT OF TIMMIE JEAN LAUNCHED TWO CULtural tsunamis: a clamor for implants and then, in the 1990s, a clamor against them. Presenting their work to the third Interwnational Conference of Plastic Surgery in 1963, Frank Gerow, Cronin’s right-hand man, held a cigar and coffee cup in one hand and Dow Corning’s Silastic gel breast “prosthesis” in the other. He reflected the beliefs of the audience when he said, “Many women with limited development of the breast are extremely sensitive about it, apparently feeling that they are less womanly and therefore, less attractive. While most such women are satisfied, or at least put up with ‘falsies,’ probably all of them would be happier if, somehow, they could have a pleasing enlargement from within.”

  It soon became the fervent stance of the plastic surgery profession that such women were legitimately diseased, either because of “micromastia”—small breasts—or because of their severe psychic inferiority complexes, a handy Freudian concept in vogue at the time. And where there’s a disease, there’s a cure. One surgeon’s autobiography was filled with slump-shouldered, depressive “before” pictures and gleeful, exuberant “after” shots. The message was clear: bigger breasts could change you from a loser to a winner. As recently as 1982, the American Society of Plastic and Reconstructive Surgery told the U.S. Food and Drug Administration that “there is a substantial and enlarging body of medical information and opinion … to the effect that these deformities [small breasts] are really a disease which in most patients result in feelings of inadequacy, lack of selfconfidence, distortion of body image and a total lack of well-being, therefore due to a lack of self-perceived femininity. The enlargement of the female breast is often very necessary to insure an improved quality of life for the patient.”1

  For three decades, Cronin and Gerow and their colleagues rushed to fill (as well as to create) the demand for larger breasts. Mastectomy patients represented 20 percent of the total. For them, implants would stand in for what had been brutally cut away with the cancer. For the rest, though, implants promised youth, a certain kind of confidence, and lots of attention. The implants came in three sizes, small, medium, and large. The largest was called “the Burlesque.” (It’s worth noting that at 340 cubic centimeters, it is now merely the average size used in Houston. Implants in the Midwest and East tend to be smaller, as well as less popular.) Gerow reputedly liked big breasts, and it apparently wasn’t unusual for him to take a look at an unconscious woman on the operating table in whom he had just placed implants, decide she could handle bigger ones, and redo the whole thing.2 With royalties on the devices, the men made a lot of money. So did a lot of other surgeons. One Houston doctor boasted that he could perform as many as seventeen breast augmentations a day. He built a breast-shaped swimming pool for himself, with a Jacuzzi for the nipple. If it were up to me, that would be the site of the nation’s implant museum.

  By 1985, one hundred thousand women were getting breast augmentations a year, adding some thirteen thousand gallons of silicone gel annually to the nation’s mammary capacity. By 1992, two million women had implants, fueling a $450 million industry.

  Especially in the beginning, women from the entertainment industry represented an outsized portion of patients. These were also the women clamoring for silicone injections, a practice that continued well into the 1970s and was mostly performed by “cosmeticians.” It was cheaper and easier than undergoing implant surgery. From its illicit origins in Japan, the option was popularized in the United States by San Francisco’s Carol Doda, credited with being the country’s first topless go-go dancer. In 1964, while dancing at the Condor Club, she underwent forty-four injections of silicone, turning herself into an overnight sensation and winning the title of “the new Twin Peaks of San Francisco.” It is no understatement to say that Doda changed the landscape of breasts. By 1965, she was appearing in Las Vegas and insuring her mammary assets for $1.5 million. In 1968, Tom Wolfe immortalized her anatomy in The Pump House Gang: “Carol Doda’s breasts are up there the way one imagines Electra’s should have been, two incredible mammiform protrusions, no mere pliable mass of feminine tissues and fats there but living sculpture—viscera spigot—great blown-up aureate morning-glories.”

  Doda dangled her glories before San Francisco’s power brokers while dancing the Swim, the Twist, the Frug, and the Watusi. She did this to live music from a white hydraulic piano that moved up and down. Now that’s entertainment. (A word about that piano: it once again made headlines in 1983 when a bouncer shtupping a stripper after hours on said piano was crushed to death after accidentally activating the hydraulic system. The trapped woman waited several hours to be freed by a janitor.)

  Thanks to Doda’s volcanic success, the pneumatic look became de rigueur for any self-respecting topless dancer, and patrons came to expect it. The strippers instantly saw their tips increase. Corresponding with the popularity of hometown implants, Houston became the strip-club capital of the world. Rick’s Cabaret anchored the city’s club scene. The club’s average bust size was a 38D, according to the Texas Monthly. Founded in 1983, it supplied more models to Playboy than any other club. At one point, it was American Express’s largest charge customer. Setting up franchises across the country, it went on to become the first publicly traded strip joint. Big breasts were going national.

  I looked up Doda, half expecting her to be a tenderloin junkie long dead from some sort of silicone poisoning. But once again, my knockered preconceptions were knocked upside down. Doda went on to live a long and rather fabulous life. Now well into her seventies, she currently owns a lingerie store in a fashionable San Francisco neighborhood and makes occasional appearances with her band, The Lucky Stiffs.

  Despite the contribution by Doda and her followers to the GDP, federal regulators were not on board with silicone injections. Because the substance was being injected, the FDA classified silicone as a drug in 1965. Alarmed by its poor quality, the agency then prohibited Dow Corning from selling industrial-grade silicone to medical or beauty practitioners and restricted the use of the “medical-grade” stuff to only eight doctors for controlled studies. Even so, an underground trade flourished. An investigation revealed that by 1975, more than twelve thousand women had received injections in Las Vegas alone. There were reports of infection, gangrene, necrosis, and amputations. By 1971, at least four women had died from silicone embolisms, clumps of silicone that had lodged in their lungs or brain. The press covered stories of “Tijuana silicone rot.”

  While injections were regulated, implants were not. They were classified as a “medical device,” not a drug, and the FDA did not have authority to regulate medical devices until 1976. Even then, lobbyists ensured the implants were grandfathered in, meaning they did not need to go through an approval process as long as the manufacturer kept the agency updated on any safety problems. It was an eerie parallel to the sixty-two thousand chemicals also grandfathered in that same year under the new Toxic Substances Control Act (for more on that, see chapter 5). In both cases, the lure and power of technology—technology that would alter women’s bodies in wholly unexpected ways—trumped consumer protection.

  From the beginning, Cronin and Gerow knew they had some problems on their hands. The sac did not, in fact, prevent the breast from hardening, and the silicone gel proved harder to contain than they’d hoped. The first-generation implants had a ridgelike seam that could be felt on the sides of the breast. Many patients—41 percent, according to a 1979 study—experienced loss of nipple sensation. An enormous percentage of patients—around 25 to 70 percent by ten year
s—suffered “capsular contracture” in which the body walled off the implant by creating fibrous scar tissue around it. The scar shell then tightened and shrank, contributing to a visual that became known as “the doorknob effect.” If silicone injections came to look like a bag of rocks, the implant resembled one big shriveled stone. A Houston neurologist, who was openly critical of implants, told me he once saw a patient who had been shot. She was a showgirl, and her implants were so hard that the bullet bounced off and saved her life. “They were like doorbells,” he said of her breasts.

  Doctors speculated the contracture was a response to contamination and infection. Early dissections of the affected tissue revealed that pieces of paper, wood, cotton, talc—essentially pieces of the operating room—had routinely lodged on the implants. The operation itself, initially performed with fairly crude implements like scissors, resulted in a lot of blood and hematomas—gnarly bruises—around the implant. Eventually, surgeons would develop a cleaner, “no-touch” technique with fewer side effects.

  Implant makers also attempted to address the problems. Dow Corning created a thinner, seamless bag. That solved the ridge problem, but the bag was so thin the gel freely oozed out of it (this was known as “gel bleed”), and the bags ruptured more easily. Company salesmen were told to wash the leaking implants with soap and water before presenting them to surgeons.

  “We had the silicone catastrophe because the implants were made with a not totally impermeable barrier,” Biggs, now a retired plastic surgeon in Houston, told me. “It was a bad product.”

  Beginning in 1982, manufacturers introduced a new, polyure-thane-foam-covered implant, called Meme, in hopes it would keep breasts from becoming bulletproof. Patients with these implants did experience lower rates of capsular contracture, and by 1991 this was the most widely used device. But the reason for the success was that the foam was evidently breaking down in the breast, causing a prolonged inflammatory response and “microencapsulations,” in which “multidirectional contractile forces cancel one another.”

  In fact, as the implants got better, they were actually getting worse. Despite some sporadic earlier testing, it wasn’t until 1991 that the FDA released a report that the foam was releasing 2,4-toluenediamine, a known carcinogen. Within days, Bristol-Myers Squibb withdrew Meme from the market. But by then, at least 110,000 women had received those implants. Amazingly, the polyurethane foam being used in the breasts of women was the same stuff headed for carpet pads and carburetors. It was never reformulated for medical use, and the manufacturer of the foam was apparently surprised to learn where it was ending up. Many surgeons remember these implants fondly, and foam-covered implants continue to be used in Europe and South America.

  (Lest you think the Europeans are making better products, however, a glimpse into the 2011 French implant scandal will set you straight. Jean-Claude Mas, the seventy-two-year-old founder of Poly Implant Prothèse [PIP], is currently facing criminal charges in France for fraud and injury. For nine years, PIP sold implants secretly made with cheap industrial silicone including fuel additives and other chemicals never studied or approved for medical use. The adulterated implants, now installed in a quarter million woman throughout Europe and South America, are believed to be rupturing at higher than expected rates and causing inflammation.)

  By the time of the foam revelations in the United States in 1991, another, bigger wave was crashing. Patients whose silicone implants had ruptured were reporting various idiopathic illnesses, everything ranging from fatigue to joint pain to lupus. The stories were all over the media, in the hearing rooms of Congress, and in the mailroom of the FDA. Several multimillion-dollar judgments were awarded to individual patients in juried courtrooms. The agency’s commissioner at the time, David Kessler, stated that “we know more about the life span of automobile tires than we do about the longevity of breast implants.”

  In 1992, the FDA issued a moratorium on silicone implants except in women following breast cancer surgery who agreed to participate in clinical studies. (Saline implants were still available.) By 1995, half a million women were suing the makers of implants and their surgeons. Faced with 20,000 lawsuits and 410,000 impending claims, Dow Corning declared bankruptcy. The company eventually entered into a $3.2 billion settlement with 170,000 women. It was the largest-ever class-action settlement at the time.

  A recent college graduate, I clicked into the implant controversy around the time of the moratorium. I’d studied pesticide contamination of farm workers, chemical-plant explosions in Bhopal, and radiation poisoning in Chernobyl. Then an Exxon tanker cracked open in Valdez, Alaska, leaving birds slickened and imperiled. When I saw numerous news reports that plastic implants were rupturing inside women, who then came down with mysterious immunesystem ailments, it seemed to make perfect sense as another example of corporate malfeasance and crimes against nature.

  But now, after twenty years of study, science has not backed up most of these claims. Research to date has found that women with silicone implants, even the older versions, do not have more immune-system diseases than their au naturel peers. Some research suggests that they have slightly higher rates of immune-related symptoms such as fatigue and arthritis, but other studies contradict that. In 2011, the FDA reported that implant patients have higher rates of a very rare cancer called anaplastic large-cell lymphoma. This cancer grows in the cells of the scar tissue surrounding the implant, but it is distinct from breast cancer. Implant patients do not have statistically higher rates of breast cancer, but they do have higher rates of lung and brain cancer. This is possibly because of migrating silicone, but more likely due to associated lifestyle factors such as smoking.

  To be sure, many things are still distressing about the implant story. Doctors and manufacturers profited by introducing a poorly understood substance into women’s bodies. Implants were not engineered well at the beginning, they were inadequately tested, and patients were not always informed of the many real risks of the surgery, or of the high failure rates of the devices. Ultimately, the immune-system scare became a distraction from these other issues. As the legal scholar Julie Spanbauer put it in 1997, “The message that never reaches the public is that the majority of women with breast implants, those who received their implants before approximately 1992, have become nonconsenting, de facto participants in these and, unfortunately, in future safety studies.” But the crazy thing about the implant story is that no one comes out looking clean. Everyone was out to exploit everyone else, the media included. The implant patients themselves proved able opportunists; if the medical studies are correct, many more women jumped on the classaction gravy train than had claim to do so.

  After 1992, the numbers of women receiving implants in the United States briefly plummeted from a high of 150,000 to about 30,000 annually during the conditional moratorium. But by 2007, a year after the FDA approved the next generation of silicone implants—still based on the original Cronin-Gerow concept of gel in a baggie—that figure had increased nearly 1,000 percent. Despite the recession, the worldwide market for breast implants is roughly $820 million a year and growing at 8 percent a year. Between five and ten million women are walking around with implants.

  After a fourteen-year silicone hiatus, the fake-boob industrial complex was fully back in business.

  BEFORE I LEFT HOUSTON, I WAS INVITED TO OBSERVE DR. CIARavino in action. I was curious to know who his patients were and, I suppose, to bear witness to this visceral alteration of the natural breast. I steeled myself for the operating room by watching stills and YouTube videos of implant operations. One set of photos showed how the nipples were cut open and tubes placed in them to fill saline sacs. It gave the term breast-feeding a whole new visual. This is nurture turned on its head, a gut-churning reversal of lactation.

  Fortunately, I would be spared that. Ciaravino prefers to work through a small, neat incision under the breast in what’s called the inframammary fold. He has a kind and compassionate staff, and he uses an experienced anes
thesiologist. If you want implants, this seems to be a good place to come. Ciaravino is known for what he calls a “no-bleed” surgery. He cleaves the chest muscle from the rib cage using a pen-sized cauterizing tool that seals the tissue as it goes. He doesn’t want blood because a dry seal around the implant reduces risk of encapsulation and because iron is a primo nutrient for bacteria.

  Katye had assured me that implants “are the most studied medical device in history,” and that they are now “100 percent safe.” But are they? The truth is that ongoing studies continue to raise basic health questions, and the FDA and even implant makers acknowledge as much. When the agency approved the new silicone implants in 2006, it was under the condition that manufacturers carry out ten-year follow-up studies. In its fifty-two-page product insert data sheet for MemoryGel implants, the Mentor corporation summarizes the results of the first three years of this study. In addition to finding an eye-raising three-year complication rate of 36 to 50 percent for implant patients (including trickier cancer reconstruction patients), the insert states, “Compared to before having the implants, significant increases were found [in patients] for fatigue, exhaustion, joint swelling, joint pain, numbness of hands, frequent muscle cramps, and the combined categories of fatigue, pain, and fibromyalgia-like symptoms… These increases were not found to be related to simply getting older over time.”