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Breasts, redefined

Forget the natural look. More American women than ever are turning to implants.

June 13, 2005|Shari Roan | Times Staff Writer

If all goes well, Akinyi Okoth, a single, 32-year-old Manhattan woman, will come home from a lengthy vacation later this summer with the breasts she has long wanted.

Like a quarter of a million U.S. women each year, Okoth plans to have her breasts enlarged with implants. She's always felt unfairly shortchanged when it comes to her breast size, she says, pointing out that her sisters are well-endowed. Besides, she thinks clothes look better on bustier women.

"I feel good about myself, but I think breast implants will make me look better and change the way I think and act," says the information technology professional.

The Food and Drug Administration may still be considering whether silicone gel implants -- like saline implants -- are safe for general use in augmentation, but for Okoth, it's a moot point. She's made up her mind to obtain what nature itself didn't create.

Her determination underscores a point that has often been overlooked in the debate over the safety of silicone implants, pulled from the market 13 years ago: U.S. women want augmentation, silicone or no silicone.

Even as public health officials, breast manufacturers and anti-implant activists have been warring over the risks of silicone implants, more women than ever are paying the price -- and taking the risk -- to have perkier or bigger breasts.

Sometimes the changes are subtle, noticed primarily by the woman herself. Often they're obvious, meant to be noticed by almost everyone. In any case, augmentation no longer carries the stigma it once had.

In 1992, the year silicone implants were banned for general use, an estimated 32,607 women underwent augmentation -- elective surgery to enhance breast size. Since then, augmentations have soared to an estimated 252,915 a year, according to the American Society of Plastic Surgeons.

"Breasts sell," said Ann Kearney-Cooke, a Cincinnati psychologist who has studied body image. "Whenever you have a body part that there is such a high charge around in the culture, I think that is when you see people getting obsessed and dissatisfied."

In part, the popularity of augmentation surgery can be traced to the growing overall acceptance of plastic surgery. Cosmetic procedures have increased 26% since 2000, the plastic surgeons group says.

"The whole idea of remodeling your body has become a fashion statement, almost like changing your wardrobe," says Rita Freedman, a clinical psychologist in Harrison, N.Y., who has studied body image and breast implants.

Even taking that trend into account, breasts have become bigger than ever.

Aggressive marketing and advertising, fashion trends and cosmetic surgery television shows such as "Extreme Makeover," have all contributed to a culture in which full, bouncy, youthful breasts are part of the ideal female body image, says Freedman.

Large breasts "are advertised indirectly every time a Victoria's Secret ad comes into your house," she says.

A woman fresh from a plastic surgery center may still elicit the occasional snicker, but many more women undergo augmentation with no embarrassment. A brassiere manufacturer, Bra straps.com, recently introduced a new bra intended to create the appearance of breast implants by lifting and separating each breast to achieve that can't-be-natural look.

The rounded, high profile of implants may not be normal, but they can seem to be the norm. In some social circles, there may even be pressure to conform.

"It's the fashion to have done it rather than not to have done it," says Freedman. "People used to go to South America and have it done in secret. Now people come back after surgery almost bragging about what they've done."

Once a procedure -- whether Botox or face-lifts or implants -- achieves critical mass, women can find themselves questioning why they aren't undergoing a makeover of some sort. Shunning cosmetic surgery, in some social circles, can be a new version of "letting yourself go."

"Cosmetic surgery has a way of creeping down the block," Freedman says. "You catch the need for it. Something that seemed OK to you before, when you see someone else has corrected it, it's not OK any more. [The need] travels among the family. It travels among the social circle."

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Different motivations

Augmentation patients typically fall into three groups, says Dr. Steven Teitelbaum, a Santa Monica plastic surgeon. These include women who want the "Baywatch" look; what Teitelbaum calls "the smallest group but, unfortunately, the poster child for augmentation." These mostly younger women were children when implant safety questions first emerged, he notes, and may be especially disinterested in the safety controversy.

The more typical augmentation patients, he says, are women who never developed breasts during puberty and the "postpartum" group, women whose breasts were once satisfactory but have changed due to aging, pregnancy and breast-feeding.

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