by Lizzie Stark
The day after the funeral, my aunt Cris and I ran a few errands together. In his grief, my grandpa wanted many of Meg’s effects quickly sorted and donated, so we went to the women’s health center at the University of Arkansas to donate my grandmother’s prostheses in hopes some other, possibly low-income woman might get some use out of them. The prostheses, silicone things placed into pockets sewn into special bras, cost around $100 each.
The Halsted mastectomies my grandma underwent in 1968 and 1978 saved her life, but left her chest caved in. Without the prostheses, she looked as flat chested as a paper doll. Worse than flat chested, really—Halsteds made some women’s chests concave. Luckily for my grandmother, the woman who put breasts on children’s dolls would also put realistic falsies on women with mastectomies.
Barbie creator Ruth Handler developed breast cancer and underwent a mastectomy in the 1970s. As she wrote in her autobiography, the experience changed her self-image. “Losing a breast made me feel dewomanized. I’d been proud of the way I looked. I was well built and my designer clothes showed off my body. Now I felt the surgeon had taken the part of me that made me feminine and attractive…. I’d like to chop off parts of that doctor.” Afterward, she wanted a little something to fill out her bra, so she started asking around. Her doctor told her to take some balled-up stockings and put them in that side of her bra. That didn’t satisfy her need to look natural, so she went to a department store and asked. The salesperson took her to a dressing room and handed her a bra and a pair of gloves. Handler stood, confused, in the dressing room until finally she figured out that she was probably supposed to stuff the gloves into the bra. At a lingerie shop in Beverly Hills, she asked for a prosthesis, and the staff treated her request like a shameful, illicit deal, speaking only in whispers. The egg-shaped sack of liquid they handed her looked weird in her bra. In fact, the prostheses weren’t even sized in conjunction with bras. Handler found this idiotic. “Every woman knows that her two breasts are as different as her two feet,” she wrote. “We wouldn’t think of putting the same shoe on both the right and left foot, would we? It was obviously designed by a man who didn’t have to wear it.”
So Handler decided to remedy the problem of bad prostheses and sales staff who didn’t know how to treat customers with mastectomies. She had a prosthesis-maker cast her chest, and after a few tries she’d developed a more winning breast substitute made of foam and silicone. She founded Nearly Me, Inc., a company that sold prostheses sized to fit bras, that came in left and right versions, and weighed the same as the absent breasts. Ruth and a team of eight middle-aged breast cancer survivors marched into department stores where they trained salespeople in how to fit new survivors with kindness. Ruth even fit First Lady Betty Ford with a prosthesis after her mastectomy.
After the woman at the health center brought the receipt for my grandma’s prostheses, Cris and I went back to the car.
“You know, Lizzie,” my aunt said. “It occurs to me that this might not have been the easiest stop for you.” It wasn’t. I’d been carefully thinking light thoughts, reading flyers tacked to a bulletin board near the waiting room, looking forward to lunch later with all the relatives. For the first time, my aunt and I began to talk about the family curse. “How are you doing with all this?” she asked. “Do you feel crazy? Because I was a wreck in the months before my mastectomy, and it’s very normal.”
I did feel crazy. I felt crazy, desperate, and out of control. I often started and ended the day thinking about what had happened to my family and about what would happen to me, and I’d cry. Thinking about my breasts made me cry. Trying not to think about them also made me think about them, which made me cry. On breaks, I’d cruise cancer websites and read other women’s stories, which were so sad I’d cry for them too. In fact, just the word “cancer,” well, that could do it. It was stupid. It was stupid to be so sad about something that wasn’t even cancer. Compared to my mother and grandmother, I was getting off lightly. I didn’t deserve sympathy. I was a pathetic excuse for a human being. And that also made me cry.
My aunt’s statement—that she’d had an emotional time before her surgery—felt like a revelation to me. During the ham Christmas, she’d probably been having a lot of feelings, which meant that I wasn’t a unique irrational snowflake, a freak, a mutant drama queen. My aunt’s acknowledgement of the fraught nature of this waiting period gave me permission to let up on myself. It felt freeing.
On our way home to my grandpa’s apple orchard, we talked implants. I’d read that many women had only one regret about surgery—that they didn’t go bigger. In contrast, I learned, my aunt went smaller and was very happy about that.
It’s weird to think about selecting new breasts. If I go slightly larger or smaller, what does that say about me and my vanity? Will my new ones feel like breasts? Will I miss the old rack? The technical aspect yields more questions, because there are so many options. Do you go with implants? If so, silicone or saline? Or flap surgery transporting tissue from the back, stomach, or butt? Or a mixture of both flap surgery and implants? If you choose flap surgery, will the tissue get tunneled under your skin or cut free of your body and reattached with microsurgery? Will you keep your nipples, have them tattooed on, or rebuild them with darker skin from your groin, or will you stick with nippleless “Barbie-breasts”? Because this is kind of permanent.
Surgeons offer a vast number of procedures today, but it wasn’t always so. The discipline of plastic surgery grew out of the ancient psychological need for wholeness, for love, for social acceptance, needs that found modern, narrower expression in the individualism and consumer culture of the 1960s and 1970s. And of course, as always, war drove many of the technical advancements that permit today’s procedures by offering up plenty of victims with the desperate desire to regain a normal appearance by any means.
The surprisingly long history of reconstructive surgery begins with the Indian doctor Sushruta, sometimes known as the “father of surgery,” who lived sometime between 600 and 800 BCE. An important figure in the history of medicine because his surgical texts traveled widely after being translated into Arabic, he made many advances—including the use of wine and marijuana as a primitive form of anesthesia. He also had a method for reconstructing noses out of patients’ cheeks, cutting skin flaps that he sutured together to make new noses. As early as 1000 CE, Indian surgeons cut inverted spades of skin from their patients’ foreheads and twisted them down to make new noses, leaving the points attached to preserve blood supply. The forehead flap, passed down through the generations, became known to English surgeons in 1794 and is still called an Indian flap today. The numerous street fights in Bologna, Italy, in the late 1500s damaged faces and inspired Gasparo Tagliacozzi, who was familiar with Sushruta’s work, to create a new technique for nasal reconstruction. He made cuts around the nose and on the patient’s upper arm, then stuck the patient’s arm to his nose, immobilizing it with a steel contraption that looked like a torture device. After a few weeks, when the graft had taken, he’d cut the flap free from the arm and fashion a new nose.
Violent street fights propelled Tagliocozzi’s new nasal advancement, and much later, the carnage of World War I would accelerate the field of plastic surgery. The war yielded an unprecedented number of facial injuries. Bombs dropped into trenches exploded upward into heads and necks. The steel helmets meant to save lives sometimes turned lethal, blown apart into fragments that hit comrades’ faces along with projectiles. Early airplanes were dangerous and maimed pilots and passengers during crashes. Moreover, it often took days for the injured to arrive at hospitals, further complicating treatment.
The British Army had only fifteen dentists at the beginning of the war, so US ambassador Robert Bacon suggested to the president of Harvard that the university sponsor a medical unit. Columbia and Johns Hopkins joined in, sending thirty-five doctors and surgeons, three dentists, and seventy-five nurses over. The injuries they saw shocked and horrified them. Varaztad Kazanjian, a dentis
t with only two years of the experience, rose to the challenge. He wired crushed jaws together, improvised facial splints, and figured out how to put rubber inside people’s faces so their wounds wouldn’t contract until they got somewhere where bone grafting could be attempted. They called him the “miracle man of the Western front.”
The war drove other advances in plastic surgery too, in the field of skin grafting. Ear, nose, and throat doctor Harold Delf Gillies, one of the fathers of modern plastic surgery, wrestled with a core problem of the discipline: it’s easier to nip and tuck than sculpt new features. Gillies, working in Sidcup in 1917, and Vladimir Petrovich Filatov, working in Odessa in 1916, independently pioneered a new grafting technique, the tubed pedicle. Surgeons cut a long U-shaped portion of skin from the patient’s body near the intended graft site and then stitched the long sides together to make a tube. They attached the end of the tube to wherever new tissue was needed for reconstruction. While the new skin took, patients looked like freakish aliens, with long, weird fleshy things dangling from their faces, but Gillies wrought astonishing transformations—turning monsters into men. Though now it’s been replaced by vascular surgery and microsurgery, the tubed pedicle represented a major advance; it reduced the likelihood of infection in the pre-antibiotic world by keeping donor tissue enclosed by skin and helped maintain the blood supply to the new tissue. It also meant Gillies could rebuild noses and other facial features that had been blasted off, giving horrifically disfigured soldiers new leases on life.
During the war and after, Gillies trained scores of surgeons—mostly Americans who sought him out as a teacher. My countrymen dominated the emerging field, perhaps because it appealed to our vanity, or because in a classless society appearance spoke silent volumes about parentage, and in the great melting pot, it didn’t do to look like the new immigrant. By the beginning of World War II, we’d have about sixty practicing plastic surgeons—ten times as many as Britain and almost double the combined total of the rest of the world, according to historian Elizabeth Haiken. By the early 1920s, we’d published the first respected plastic surgery textbook, and two American medical schools had departments dedicated to the new discipline.
After the war, when most of the blasted faces had been put together again, a glut of new specialists met a dearth of patients. The specialty would have to unearth a fresh market in order to survive. They had fixed disfigured men. Perhaps they could improve on the physically imperfect, a category that would, by the next century, come to include almost everyone. In 1921, these two threads—the new surgical discipline and an unattainable standard of beauty—began to intertwine. In August a group of doctors that would later become the American Association of Plastic Surgeons met in Chicago for the first time. A month later in Atlantic City, women vied for the title of the fairest at the first Miss America pageant. Yearnings for physical perfection no longer had to remain mere thoughts—as psychiatry entered the American consciousness, these longings became disease, inferiority complexes that the scalpel could slice through, offering a physical cure for a mental ailment, as surely as mastectomy attempts to cure fear of breast cancer in BRCA patients.
Though philosophers might opine that beauty is eternal, breast fashion says otherwise. Between the Middle Ages and the Renaissance, the ideal breasts were “small, white, round like apples, hard, firm, and wide apart,” according to historian Marilyn Yalom. Breasts telegraphed social status. Upper-class women could afford wet nurses and thereby avoided stretching their breasts, while large bosoms afflicted the poor, who breastfed their own kids and served as wet nurses for the wealthy. In the last century, the vogue has shifted every few decades—small breasts for the boyish 1920s fashions, torpedo-shaped large busts to welcome the men home from World War II, and then flat-chested again for the waifish fashions accompanying the feminist revolution of the late 1960s and early 1970s. After the push-up bra made inroads into the underwear market, large racks have enjoyed a resurgence. As a 1988 Wall Street Journal article proclaimed, “Breasts are back in style.”
Surgery has followed the fashions. In the 1920s, cosmetic breast surgery focused on reductions and lifts for women with professions like dancing that required a certain body shape, and for women who couldn’t enjoy normal stuff like sports without discomfort. By the 1950s, with the flat-chested flapper fashions long gone, the breast took on expanded meanings. US soldiers received “morale-boosting” pinup photos during World War II featuring women with prominent busts. The “breast fetish” and breast-centric fashions of the war and post-war periods, Yalom argues, “corresponded to very basic psychological desires” and carried clear messages for men and women. The breast-centric culture reassured men that the nightmare of war had ended and offered them the bosoms they’d dreamt of, while also keeping women in their place. They let women know, Yalom writes, that “your role is to provide the breast, not the bread…. It would take another generation to contest this vision of gendered fulfillment.”
After World War II, the growing medical expertise of American plastic surgeons collided with rising acceptance of psychology and Freudian theory, leading patients to seek physical treatment for psychological conditions. The fad for big breasts made small ones into a disease; plastic surgeons said that women on the Itty Bitty Titty Committee suffered from “micromastia” or “hypomastia,” wonky names suggesting an exotic tropical malady rather than a state within the normal variation of human bodies. At the same time that small breasts became an illness, the longing for a Marilyn Monroe rack became a mental syndrome. Psychiatrists described typical enhancement patients as “psychologically healthy-appearing individuals whose self-confident exteriors masked their true feelings of inadequacy, low self-esteem, depression, and neurosis,” according to medical sociologist Nora Jacobson. Flat-chested women suffered from inferiority complexes.
Plastic surgeons and psychiatrists fed on one another. Surgeons recommended that women seeking augmentation undergo psychotherapy first, which meant more clients for shrinks, and also established among psychiatrists “the idea that surgery could be a legitimate treatment option for certain kinds of emotional maladjustment.” Dramatic physical operations could cure mental malaise by revising the body itself. Or, to put it another way, it’s easier to slice yourself open than to alter the prevailing beauty standard. The hell of it is that once you’ve altered yourself to fit a narrow definition of beauty, you become part of that oppressive establishment.
Technology cannot keep pace with women’s yearnings. After my mastectomy, I didn’t want something that merely looked like my missing breasts—I wanted exact replacements, down to skin sensation and breastfeeding ability. I didn’t want to remove my breasts at all, just their ability to get cancer. But since that was an impossibility, I would settle for the best that plastic surgery could give me, an operation built on more than a century of mad science performed on the willing bodies of other women.
One of the earliest breast reconstructions ranked pretty low on the crazy scale. In 1895, Heidelberg surgeon Vincenz Czerny removed a tumor from a woman’s breast and filled in the hollow with some fatty tissue from her hip or butt. A year later, her breast still looked good. Though today you’d sue the surgeon who gave you a uniboob, in 1903 Hippolyte Morestin described a reconstructive operation on a mastectomy patient that cut part of her remaining breast free and stretched it across the chest to make a single mound. Louis Ombrédanne described a technique for immediate reconstruction following a mastectomy in 1906—he flipped one of the minor chest muscles around, reattached it in a mound, and then covered it with skin. In the 1920s and 1930s, some surgeons continued Czerny’s experimentation with fat not as a method of reconstruction but for augmentation, finding that the body absorbed it unevenly, leaving scars at the donor site and lumpy uneven breasts that looked ugly and made breast cancer diagnosis difficult. By the 1940s, transplants included skin as well as fat from the donor site to help ensure the graft didn’t go necrotic, but the results were similarly unacceptable. Though
a vast cavern of medical advancements separates these operations from today’s, the basic idea is correct—it’s possible to use a patient’s own tissue in breast reconstruction.
But we didn’t come here, back more than one hundred years, to hear about good ideas. We’re here as voyeurs, to gawk at the two-headed fetal pigs in jars, the medical procedures relegated to the creepy basement with the gimp and that eugenics book inherited from our racist ancestors. Surgeons in the early to mid-1900s tried to put a lot of random stuff into women’s tits, including glass balls, ivory, ground rubber, ox cartilage, and polyester wool. But for the real catalog of horrors, we’ve got to look at injectable fillers.
