Victoria’s Other Little Secret

Exploring the psychological benefits of breast augmentation and reduction

By Nancy Yang • Photos courtesy of Dr. Matt Concannon

I’m locked in a dressing room staring down a half-empty bra, waiting for the miracle part to kick in. A décor of pink and gold evokes fantasies of a French boudoir, but the brazen mirror before me drives home the naked truth. My image more closely resembles the boyish chest of a metrosexual than anything remotely “Victorian.”  Welcome to the world of the unendowed, where proportion eludes you and the price of visible hip bones can be a bosom that doesn’t exist.

A couple of women who understand my plight fill me in about breast augmentation, a possible solution to my dilemma. “I never wore a halter top—are you kidding?” quipped a gregarious woman of 28. Her straightforward humor suggests a fearless invincibility, so what she says next surprises me: “The surgery helped me gain the confidence I never had. I had always been outgoing, but when you have self-confidence it helps you become a better person.” Her new-found confidence improved her work performance and her relationships, she added. “My fiancé said he’d still love me if I didn’t have them—but now he says I’m hot.” She paused for a moment before affirming what had permeated our conversation. “I wasn’t doing this for anyone else,” she said. “It’s the best thing I’ve done to date with my life.”

A second woman struggled with the idea of augmentation. Before her pregnancies she had enjoyed her shape, but breast feeding took its toll. “Everything sort deflated,” she said. “I almost felt concave.” The condition worsened when she lost weight, so she began using gel enhancers. Once, she inserted them in a bikini top and went swimming, only to discover one had launched itself into the abyss of the local pool. She was mortified. “I wanted to create what I had been faking all this time so I could be balanced,” she said. On the other hand, she was reluctant for three very important reasons: her children. “I was concerned about what my daughters might think,” she said. “It’s important that they like who they are, and I don’t want to appear immodest.”  In the end, an unfortunate event brought resolution. Removal of a precancerous tumor in her breast required plastic surgery, and augmentation was a reasonable part of the package.
“I tell my breast augmentation patients that we do a lot of homework beforehand,” said plastic and reconstructive surgeon Matt Concannon. He recommends patients follow suit by doing a little homework of their own. “People don’t spend enough time researching their surgeons,” he said. “It’s best to shop around and get two or three opinions. Psychologically there’s a lot of nuance to this.” Concannon often finds the public unaware of certifying bodies such as the American Board of Medical Specialties or the American Board of Plastic Surgeons. Additionally, surgeons differ in their preferences for important factors, such as incision sites and whether or not to use the recently approved silicone gel implants.

“Silicone implants are probably the most studied medical device in the history of mankind,” said Concannon. Today, he often recommends the new gel implants but tells his patients that if they’re at all doubtful they can still have a nice result with saline. He describes the 1992 to 2006 moratorium on silicone for cosmetic use as a case in which persuasion and anecdotal data trumped epidemiologic evidence. “I’m pretty sure it’s where junk science got its name,” said Concannon. Back in 1990, Connie Chung’s coverage of silicone implants aired on the CBS program “Face to Face” and created concerns about implants and the companies that manufactured them. Lawsuits involving claims of auto-immune disease and connective tissue disorders eventually brought down implant maker Dow Corning.

“Dow lost; the women got $1,200—some didn’t even get that—and the attorneys won,” said Barbara Howard, a cosmetic plastic surgeon in Jefferson City. “The rest of the world never took our saline detour.” Other countries continued to use silicone implants, which are generally preferred over saline because the fluid wave moves more slowly and naturally, she says. From looking at the implants side by side, I begin to understand why women might prefer silicone’s more natural appearance. “It’s the consistency of very fresh Play-Doh,” she says.

Plastic and Reconstructive Surgeon Gregory Croll presents a different perspective. “I don’t use silicone. Even though the data since the moratorium proved it was safe, I think there are still potential problems.” He cites the possibility of a rupture or microscopic gel bleed that could cause complications that wouldn’t happen with saline. Also, he points out that in spite of the more pliable feel of silicone implants, the appearance of saline-enhanced breasts resembles silicone and that saline patients are typically happy with the results. Surgery has its costs, he said. “It’s not a biological, psychological or financial freebie.”

For Emily Speaks, the benefits of surgery outweighed its costs. Fifteen years ago, she was dealing with an embarrassment of riches. “I hated my breasts,” she says. “Whoever called them a blessing, I’ll never understand.” When she was 16, she wore a triple D cup that overwhelmed her small frame and elicited unwanted attention. “I tried to disguise them by wearing men’s shirts, but they’re just out there—no one ever seemed to look at my face. I felt like saying I’m up here, people!”  Running in P.E. class or wearing a swimsuit were out, she said. “I felt like an odd ball, and as a teen you don’t need any more help with that.”
But help is exactly what she received, and it was to become a gift of a lifetime. When the Christmas holidays rolled around, Emily’s cousin Julie came to visit. During a conversation about the difficulty of finding a prom dress to accommodate Emily’s curves, Julie, a former Miss Illinois contestant, offered a question. “She asked Emily if she had ever considered reduction,” said Iris Shoemaker, Emily’s mother. “She explained that several friends had undergone the procedure and were very pleased with their results.”

The teacher and wise mother in Iris must have recognized there are moments when love shines brightest through restraint, so initially she said nothing. “A couple of days later I asked Emily if she’d be interested,” she said. “I think Julie gave Emily encouragement. She was her big cousin and a young executive at ENESCO, so she was a role model.” Iris made an appointment with plastic and reconstructive surgeon Charles Lin Puckett, and scheduled a consultation. “The nurses were surprised we got in,” said Iris. “We had no referral except that he was approved by our insurance.”  Her random choice proved fortuitous. “He was wonderful,” said Iris. “In those days she was shy, so he talked to her like a loving dad.” When he asked her what she was hoping for, Emily answered: “How about to be normal?”

Emily’s response might well be universal. Barbara Howard says studies suggest humans have an instinct for proportion. Babies as young as nine months understand nature’s innate desire for balance and symmetry, a highly evolved trait that’s key among animals, birds and insects in mate selection. A recent study by William Brown, an evolutionary psychologist who reports his findings at the National Academy of Sciences, indicates that our brains are hard-wired to prefer certain body proportions in height, long legs, broad shoulders, curvy figures— and breast size. “I don’t know that there is such thing as normal,” said Jean Prange, owner of Prange Intimate Apparel, who stocks bras ranging in size from 30AA to 56K. “Bankers tell me we have much too much inventory, but I want to carry what’s right for all my clients.” Over the course of 42 years, Prange has fit many women—surgery notwithstanding—for bras that provide both a physical and emotional lift. “Each bra does something different,” she says. “It’s hard to compete with God, but that’s what we strive to do.”

I’m beginning to think that in my case Mother Nature knows best, and that our imperfections are what make us human. On the other hand, I’m reminded of a remark from one of the women I’ve interviewed: “No bra can do what my doctor did.”