Stamping Out A Dread Scourge

By Barbara Ehrenreich

In the spirit of a public health campaign, the American Society of Plastic and Reconstructive Surgeons (ASPRS) has launched a p.r. drive to "tell the other side of the ((breast-implant)) story." Public health? Slicing women's chests open so that they can be stuffed with a close chemical relative of Silly Putty? Yes, indeed, because the plastic surgeons understand what the FDA is so reluctant to acknowledge: small breasts are not just a harmless challenge to the bikini wearer or would-be topless entertainer. They are a disease, a disfiguring illness for which the technical term is micromastia.

As the ASPRS tried to explain to the FDA almost 10 years ago, "There is a substantial and enlarging body of medical information and opinion to the effect that these deformities ((small breasts)) are really a disease." Not a fatal disease, perhaps, to judge from the number of sufferers who are still hobbling around untreated, but a disease nonetheless, like the flu or TB. And anyone tempted to fault the medical establishment for inaction on breast cancer or AIDS should consider its quiet but no less heroic progress against the scourge of micromastia: in the past 30 years, 1.6 million victims have been identified and cured. Who says our health system doesn't work?

Once we understand that small breasts are a "disease," it's easier to see why Dow Corning and others rushed so breathlessly to get their implants onto the market. Why diddle around with slow, costly tests while an epidemic is raging out there? And everyone's life is touched by the tragedy of micromastia because everyone has a friend, sister, co-worker or wife who falls pitifully short in the mammary department. In the past, small groups of health-conscious males, typically gathered at construction sites, would offer free diagnoses to women passersby, but there was little that could be done until the advent of the insertable Silly Putty breast.

Admittedly, micromastia is in some ways an atypical disease. It is painless, which is why many victims put off treatment for years, and it in no way diminishes breast function, if that is still defined as lactation. The implants, on the other hand, can interfere with lactation, and they make mammograms less able to find cancer (not to mention the potential for a disfiguring or life-threatening side effect like lupus or scleroderma). But so what if micromastia has no functional impact? Why can't a disease be manifested solely by size?

Consider the rigorously scientific methods employed by the medical profession in its efforts to curb the epidemic. Not just anyone could get breast implants. No, the doctor had to study the afflicted area first to decide whether they were truly needed. For example, a friend of mine, an ( inquiring journalist of average proportions, called a New York City-area plastic surgeon to ask about implants and was told to come in for an exam. One quick, searching look and he told her yes, she needed them, badly.

In fact, according to the rumor mill, Jessica Hahn may have needed them too, as may have Melanie Griffith, Jane Fonda, Brigitte Nielsen and even, gasp, Dolly Parton. Why take chances? The doctors know there are not only obvious forms of micromastia, discernible to the man on the street, but insidious, hidden forms -- very well hidden indeed.

So we can see why the plastic surgeons were willing to cough up hundreds of dollars each to finance the ASPRS's campaign to show the bright side of the breast-implant story. Though nearly 2 million micromastia victims have been cured, millions more remain untreated, as shown by the continued existence of the plague's dread symbol -- the A-cup bra. There have been many earnest attempts to reach the untreated: public health-oriented magazines like Playboy, for example, repeatedly print photos illustrating normal breast size for the woman in doubt. Tragically, though, many women still live in denial, concealing their condition under mannish blazers and suit jackets, forgoing the many topless forms of employment.

Now a cynic might see the silicone-implant business as another malfeasance on the scale of the Dalkon Shield (which had a tendency to cause devastating infections), DES (which could cause cancer in the user's offspring) or the high-estrogen birth-control pill (which was also rushed to market after hasty and dubious testing). A cynic might point to the medical profession's long habit of exploiting the female body for profit -- from the 19th century custom of removing the ovaries as a cure for "hysteria" to our more recent traditions of unnecessary hysterectomies and caesareans. A cynic might conclude that the real purpose of the $500 million-a-year implant business is the implantation of fat in the bellies and rumps of underemployed plastic surgeons.

But our cynic would be missing the point of modern medical science. We may not have a cure for every disease, alas, but there's no reason we can't have a disease for every cure. With silicone implants, small breasts became micromastia. With injectable growth hormone, short kids become treatable dwarfs. Plastic surgeons can now cure sagging jowls and chins, droopy eyelids and insufficiently imposing male chests and calves. So we can expect to hear soon about the menace of new diseases such as saggy-jowlitis and hypopectoralis.

It will be hard, though, to come up with anything quite so convincing as micromastia. As the plastic surgeons must have realized, American culture is almost uniquely obsessed with large, nurturing bosoms. And with the silicone scandal upon us, we can begin to see why: in a society so unnurturing that even health care can sadistically be perverted for profit, people are bound to have a desperate, almost pathological need for the breast.