Breast Implants

The medicalization of women's breasts*

In the 1890s, with William Halstead's promotion of the radical mastectomy, surgeons began to regard breast cancer as a "curable" rather than "terminal" disease. In that same decade, surgeons began labeling non-pathological characteristics of women's breasts as medical problems, for instance, labeling small breasts or unequally-sized breasts as "deformities". This medicalization of women's breasts paved the way for the development of the now-lucrative branch of the medical industry devoted to breast augmentation.

Timeline:

1890s: Some surgeons began labeling small breasts as “deformed”

1940s: Some doctors began claiming that small-breasted women suffer extreme "neuroses” due to their breast size

1957: The American Society for Plastic and Reconstructive Surgeons (ASPRS) named “micromastia” (small breasts) as a medical problem

1983: ASPRS issued a statement about small breasts that read, “There is substantial and enlarging medical knowledge to the effect that these deformities are really a disease which result in teh patient's feelings of inadequacy, lack of self-confidence, distortion of body image, and a total lack of well-being due to a lack of perceived femininity."

History of Breast Augmentation Procedures*

1890s: Doctors began injecting wax and inserting various substances (including ivory, cartiledge, and glass balls) into women's breasts to increase their size. These injections and insertions were largely unsuccessful, resulting in infection, hardening of the breast, migration of substances to other areas of the body, pain, and/or death.

1920s-1930s: Doctors experimented with transplanting fat from the belly to the breast to increase breast size, but this tended to make the breasts lumpy and made it difficult to detect tumors.

1940s: Japanese prostitutes allegedly began injecting silicone in their breasts to satisfy the sexual tastes of American soldiers.

1950s: Doctors in the U.S. began experimenting with silicone injections, but the silicone tended to migrate to other areas of the body.

1950s-1960s: Doctors experimented with using sea sponges and synthetic sponges as implants, but they tended to fill with scar tissue and make the breasts harden.

1961: Doctors inserted the first silicone implants (silicone gel encased in a soft silicone shell).

1964: Doctors inserted the first saline implants (saline solution encased in a soft silicone shell).

1965: The FDA banned silicone injections.

1980s: Health advocates began questioning the safety of silicone implanted in the body. Many women with implants complained of health problems, including depression, chronic illness, respiratory problems, and autoimmune disorders. Several women filed lawsuits agains silicone implant manufacturers.

1991: The FDA placed a moratorium on silicone implants, indicating that health concerns over the safety of silicone warrented further tests. The moratorium allowed the continued use of implants for women with ruptured prior implants and for women having reconstructive surgery after mastectomy.

2006: The FDA approved two new models of silicone implants after determining that the testing done on the models had sufficiently proven their safety.

Surgical Insertion of Implants

Breast implants are placed below the mammary glands and major muscles of the breast (see frontal diagram and cross section).** The surgery typically requires three incisions, one under the breast, one under the nipple, and one near the armpit (see diagram).** Because implants have a limited lifespan, most women who choose breast augmentation need to have multiple replacement surgeries.

Risks of Breast Implants

The Institute of Medicine did a study of silicone breast implant safety and published a report of their findings online, titled Information for Women About the Safety of Silicone Breast Implants. The FDA has also published an online brochure, titled Breast Implant Risks, which includes photographs of women who have experienced complications with implants. Both of these publications state that the only significant, proven risks from breast implants are "local complications"--meaning problems with the breast tissue itself. Both publications dismiss claims that breast implants can cause or exacerbate other diseases or health conditions, such as cancer or autoimmune disfunction.

Among the most common local complications associated with breast implants is capsular contracture,** in which the body forms a capsule around the implant in order to protect itself from the perceived threat of a foreign body. These capsules are comprised of firm tissue and can create a hard, painful lump in the breast and can sometimes twist and distort the breast. One of the most common treatments for capsular contracture is "closed capsulotomy," a procudure in which the doctor applies pressure to the outside of the breast (often squeezing and twisting with his/her hands) to break up the hardened tissue. Many women need to repeat this procedure many times because the body keeps reforming the capsular contracture. Another common complication (one which Wanda has suffered in the play) is rupture.** Ruptures can be difficult to detect. Once a rupture is detected, the damaged implant must be removed.

No studies have proven links between silicone breast implants and diseases; however, doctors, health advocates, and women with implants have articulated concern that the silicone in implants may be associated with breast cancer, autoimmune diseases such as lupus, depression, respiratory problems, and other conditions, as well as health problems in infants breast-fed by mothers with silicone implants. Some doctors and health advocates argue that the studies to date are inadequate because most of them have been funded by companies that make implants, creating a potential conflict of interest in the research process. These doctors and health advocates call for further, independent research studies into potential links between silicone implants and disease. One such call came from Diana Zuckerman, PhD, in her 2006 testimony before the Standing Committee on Health in the Canadian Parliament, during hearings on whether Health Canada should approve silicone breast implants for use in that country.

Connections between Implants, Mammograms, and Breast Cancer

In 2004, the Journal of Women's Health published a study of breast implant problems related to mammograms. This study indicated that the most common mammogram-related problem women with breast implants report is an implant rupturing due to the way the mammogram process compresses the breast. The other most significant problem women report is the delayed detection of a tumor due to the fact that the implant obscures much of the breast tissue from the mammographic screening (Wanda reports this problem in the play). However, other studies have concluded that this delayed detection has not resulted in a higher breast cancer mortality rate for women with breast implants than for those without. A study published in Cancer Causes & Control in 2000 finds no evidence that women with breast implants have a higher rate of breast cancer, concluding that "breast implants do not appear to alter the risk of subsequent breast cancer".

Women's Experiences with Breast Implants

Many books, articles, and websites tell the stories of women's experiences with breast implants, ranging from stories of pleasure and satisfaction to tales of pain and suffering. Journalist Carolyn Latteier relates a number of stories, as well as some of the history of implants, in chapter four of her book Breasts: The Women's Perspective on an American Obsession.*** Numerous commercial websites contain testimonials from women who have had positive experiences with implants, including MyImplantInfo.com. The website of The Implant Information Project of the National Research Center for Women & Families offers a number of women's stories about problems with implants, including the story of television actress Mary McDonough.

*Most of the information on the history of implants and their medicalization included on this page can be found in Ferguson, Susan J. "Deformities and Diseased: The Medicalization of Women's Breasts." Breast Cancer: Society Shapes and Epidemic. Ed. by Anne S. Kasper and Susan J. Ferguson. New York: Palgrave, 2000. 51-86.

**Image from Institute of Medicine, Information for Women About the Safety of Silicone Breast Implants. Martha Grigg, Stuart Bondurant, Virginia L. Ernster, and Roger Herdman, Editors. Accessed 9/10/07. Online version <http://books.nap.edu/openbook.php?isbn=0309065933>. 2000.

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