Why are women going under the knife?

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Stylist Team
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As the implant scandal rages on and the boob job celebrates its 50th birthday, Stylist asks: why are women still going under the knife?

Fifty years ago this spring, a woman in Texas made history. Timmie Jean Lindsey, a 30-year-old factory worker, became the first person to undergo the operation to have silicone breast implants, boosting her B-cup breasts to Cs. Fast forward to today and the operation is still stealing headlines across the world. Although this time it’s not as a revolutionary new procedure, but because hundreds of thousands of women (over 40,000 of whom live in the UK) have been warned that their brand of breast implants – Poly Implant Prothese (or PIP, as the French silicone implants are referred to) – were made using industrial mattress filling. That’s right: bodies stuffed with the materials used to stuff mattresses. Last year eight women with these implants developed cancer although the authorities have now dismissed a link. However, the biggest fear is that these implants could be leaking – PIP implants have a rupture rate of 5% according to French authorities (the normal implant rupture rate is 1-2%). Quite a way to celebrate your 50th birthday.

Along with the anger directed at the company that manufactured the implants and cries of, “How could this ever be allowed to happen?” Another question is surfacing: what motivates us to do it in the first place? Of course, not all breast surgery is for cosmetic reasons. A significant proportion of women who undergo breast augmentation do so after cancer surgery, and no-one can dispute how crucial these kinds of operations can be after a mastectomy. But for those of us who choose to boost our breasts for cosmetic reasons – to undergo a general anaesthetic and risk the various complications attached – why do we do it? Who imposed this body ideal that we’re aspiring to? And most importantly, why is it women who account for 90% of all cosmetic surgery procedures in the UK?

Birth of the Boob Job

Cosmetic breast surgery procedures have been growing in numbers ever since Timmie Jean Lindsey paved the way in 1962. The shape of the implant has fluctuated dependent on societal trends – in the Seventies women wanted a teardrop shape; in the Nineties patients sought the roundest breasts possible – but the reality is the treatment has never dipped in popularity, to the point where approximately 10,000 women have breast implants in the UK each year. All this despite the fact that the current PIP scare is not the first. After the US’ 1992 silicone scare, UK women simply opted for saline implants instead. There was another blip in 2000, when 5,000 women who’d had soya oil-filled implants called Trilucent were recommended to have them removed due to toxicity concerns, but the market soon bounced back – between 2002 and 2007 the amount of women having implants went up by a massive 275%.

Neither are we put off by the risks associated with this surgery, which include infection, chronic breast pain, nipple numbness, breakage, leakage and necrosis (skin death). Not even the recession has dampened our desire for the perfect cleavage – in 2010, there was a 10% rise in breast augmentations, still by far the most popular cosmetic procedure. Surgeons report that the PIP scare has made no difference to the number of women walking through their doors. “Normally January and February are quiet for me, but I’ve had more bookings than normal enquiring about new breast procedures,” says Mr Paul Banwell, consultant plastic surgeon at McIndoe Surgical Centre in Sussex.

Female Form

Of course, the cosmetic surgery industry is not confined to breast implants. And the rise across the whole sector is staggering. Labial surgery is rising rapidly (no doubt because of the increase in porn giving unrealistic images of women’s bodies), bum implants are also on the up (an ideal likely projected by the popularity of Brazilian supermodels); 5,000 face lifts and 4,000 nose jobs were carried out last year alone. Cosmetic surgery is becoming more permissible in society than ever before. Think about it – in your circle of female friends at least one is likely to have considered nipping or tucking something they’re unhappy with, even if they wouldn’t go through with it. How many are willing to think about Botox and other injectables? It’s an attitude in marked contrast to that of most men. As one colleague’s boyfriend said, “I would never get pec implants even if they posed no risk. I imagine they’d hurt.” It’s seems to be a much simpler equation for men – surgery hurts, it’s dangerous, why would I do that to myself?

Psychologists divide the motivation for surgery into internal and external. Shockingly, one of the biggest external motivations is to please the opposite sex. According to a study by Aberdeen University, a quarter of British women who have surgery do it to appear more attractive to their other halves. Regrettably, stories of a boyfriend ‘treating’ or ‘encouraging’ his girlfriend to a bra-full of silicone are not that thin on the ground. Consciously or not, we also know men treat women with bigger breasts differently. Studies by Cornell University looking at how waitresses’ tips related to bust size found that as breast size increased, so did tips.

The internal motivation to boost self-esteem by looking ‘perfect’ is likely the strongest

But we’re not just being pushed into changing our appearance for men. The internal motivation to boost self-esteem by looking ‘perfect’ is likely the strongest. We feel we have to be exemplary in every area of our lives – but success in career, family and home are all things that can be achieved through dedication. Even the most determined can’t change the shape of their noses or the size of their breasts just through hard work. So now that cosmetic surgery alone has become affordable and easily available, if these are the things we feel are obstacles to happiness, why wouldn’t we? Psychotherapist Katrina Pitts goes further: “Dissatisfaction has to be linked to possibility, and if we are aware that it is possible to make a change, we begin to wonder whether we need that change.” And there is some evidence that it actually does make us happier. Researchers at Italy’s University of Perugia found that post-augmentation women stand straighter, feel more confident and have an improved body image.

Still, it’s extraordinary that in the 21st century, when women have achieved so much, that our physical appearance is so inextricably linked to how happy we are. Pitts says that, of the clients she sees, the women with body issues – from eating disorders to body dysmorphic disorder – vastly outnumber the men. “That’s not to say men don’t experience it,” she explains. “But if a man has a beer belly he hates and said he was considering surgery he would be mocked mercilessly. It’s interesting that surgery is far more socially acceptable for a woman.”

But obviously not all cosmetic surgery is being done under duress, or for dubious psychological reasons – nor that we are all hoping to look like Katie Price. “The women who come to see me fit three main categories,” says consultant plastic surgeon Mr Patrick Mallucci. “Most are either women who have never had the breasts they wanted or women post-pregnancy who want to regain what they’ve lost. The smallest group are women who just want really big breasts. They’re a tiny minority yet they represent the implant image.” In fact, the average implant used in the UK is a moderate 240-300cc – a B-C cup.

Common Practice

But pause for a minute – changing our bodies in order to fit an ideal that is encouraged by society, the media or men, is neither a new, nor a Western pursuit. In China, until the Communists came to power in 1949 and succeeded in stigmatising the practice as unsophisticated, young childrens’ feet were bound in order to keep them at a dainty, childlike size for life. It is thought the tradition, which involved breaking and binding the foot from the age of two, was originally practised by the wealthy elite as a mark of status demonstrating that their children did not have to undertake manual labour. Later in life it was prized by husbands who wanted to show they could afford a wife who did not need to work, but the fashion eventually spread to even the poorest classes who would go to work in the fields. The process resulted in lifelong pain and disabilities for most of its subjects.

If you think that sort of crippling torture would not have happened in the West, just consider the whalebone corsets worn by women until the turn of the 20th century that made breasts appear larger and waists impossibly tiny, displacing internal organs and making deep breathing an impossible luxury. Aesthetically, the garments flattened the waist and uplifted the bust. A small waist meant wealth and social standing, but many women developed heart and digestion problems.

There was a point surgery had become so normalised it was like buying shoes

Unfortunately these drastic methods of conforming to what society deems attractive are still taking place today. Take skin lightening in Japan, a process adopted by 60% of women in the country who use whitening products as part of their everyday routine. Throughout the country’s history fair-skinned women have been praised by men and geisha were judged by the skin on the back of her neck – the paler it was, the more beautiful she was deemed to be by the men who paid for her company.

Perhaps most extreme are the women of the Kayan people in Thailand, who have been dubbed the “giraffe” women because of the rings they wear around their necks to extend their silhouette. The weight of as many as 20 rings doesn’t actually stretch the neck, but twists the collar bone and ribs to an angle 450 lower than they would sit naturally, creating the illusion of a slender, elongated stem. Young girls may wear collars from the age of two and the coils are now used as a means to confer tribal identity and attract men, and also as a means to draw tourists to the area. The women experience bruising, discolouration and disfigured bones.

A dangerous art

Women’s bodies have always have been expected to change along with the fashions in a way that men’s have not. For example, the quest to enhance our breast size began way before medical science had a good way of achieving it – in the 19th century, women were advised to rub their breasts with abrasive towels if they wanted to make their breasts swell and in the Forties Japanese prostitutes injected their breasts with paraffin wax and industrial silicone to attract American soldiers. A pattern forms in all of them. Most of these practices were either encouraged by, or for, men.

Virginia Blum, author of Flesh Wounds: The Culture Of Cosmetic Surgery (£33, University of California Press) says, “Women are brought up to think their bodies are mutable. We’re told from an early age to change this, change that. We’re used to correction – and for a generation of women brought up thinking the implanted body is normal, surgery is just part of that.”

If there is one good thing to have come out of the PIP scandal, it’s that it has opened the discussion about the health risks involved in surgery and forced us to ask us if they’re worth it. “We had got to a point where cosmetic surgery had become so normalised it was like buying shoes,” says Mr Fazel Fatah, president of The British Association of Aesthetic Plastic Surgeons. “We focused on the cosmetic part of the phrase, not the surgery bit – we need to bring back the idea that this is a medical operation, with risks.”

Of course, we know it’s not that simple. No-one can deny the negative impact bad body image can have on your life. Cosmetic surgery provides an answer, and for many it’s a positive, complicationfree experience. The question is not whether we’re wrong to want it, it’s who suggested we should look a certain way in the first place? And why is it women who shoulder all the responsibility for adhering to this image? In reality this is a question too big to be answered here. But it’s one we’d love to hear your views on.

Share your views on cosmetic surgery in the comments below, or join the debate on the implants scandal here.

Words: Helen Foster Picture credits: Rex Features