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July 21, 1998

Cosmetic Breast Enlargements Are Making a Comeback

By DENISE GRADY
Boarding a flight from LaGuardia to Minneapolis last Thursday, passengers could not help but notice Ana Voog. Strikingly attractive, with huge brown eyes, flawless skin and cropped platinum hair, Ms. Voog, who is 5 feet 2 inches tall and weighs 90 pounds, also has remarkably large breasts for such a petite woman. Her clingy white pullover bore a startling inscription: "YES, THEY'RE FAKE."

Two years ago, when she was 30, Ms. Voog, a rock musician in Minneapolis, gave in to her longtime craving for a bust line, and had saline breast implants -- pouches full of salt water -- surgically inserted into her chest. She went into the operating room, she said, "totally flat, like not even enough for a training bra," and came out a D-cup.

"It was the most surreal thing I've ever experienced," Ms. Voog said.

Surreal or not, the experience is one that more and more American women are seeking. Cosmetic surgery to enlarge the breasts (which does not include reconstruction after mastectomy) is regaining popularity after falling out of favor in 1992. That year, the Food and Drug Administration banned silicone-gel-filled implants amid worries about potential health problems from silicone leaking out of the pouches. The number of operations plunged to 32,607, from a high of an estimated 120,000 to 150,000 in 1990.

But the count has been climbing back up and exceeded 122,000 last year, according to the American Society of Plastic and Reconstructive Surgeons. The states with the most operations are Florida, Texas and California, and plastic surgeons report that women in Texas request bigger implants than those in any other state.

Silicone gel is still banned from most cosmetic implants, but it has been replaced by saline implants like Ms. Voog's.

Why the resurgence? Plastic surgeons say the interest never died. There have always been women who wanted bigger breasts, but many were scared away by reports that silicone might be unsafe. Saline implants then gained acceptance as a safer alternative. Even though the covering is made of a rubbery form of solid silicone, it has not been linked to health problems.

Lawsuits have tried to link the silicone implants to autoimmune illnesses like lupus and scleroderma, but those links are still being debated because of absence of conclusive evidence. Some women take that as reassurance that implants are safe. The recent $3.2 billion settlement between the Dow Corning Corporation, a joint venture of the Dow Chemical Company and Corning Inc., and 170,000 women who claim to have been injured by implants did not resolve the question of whether silicone can cause systemic illness.

"I think people are feeling more sanguine about implants not being poison," said Dr. Bruce Cunningham, chief of plastic surgery at the University of Minnesota.

But saline implants are not without risk: infection and complications of anesthesia can occur, as with any surgery. Painful scar tissue can harden the breasts, and the implants can rupture, go flat and need replacing. They can also interfere with mammography.

But women are undeterred. Breast operations are just part of a larger picture: All types of plastic surgery are on the upswing, partly because a surge in the economy means that people can afford the operations, even though insurance does not cover them, said Dr. Scott Spear, professor and chief of plastic surgery at Georgetown University in Washington. Breast enlargement surgery usually costs between $5,000 and $6,000.

Dr. Roxanne Guy, a plastic surgeon in Melbourne, Fla., said that for some, breast implants have become a statement, like a tattoo or pierced eyebrow.

"Women are more empowered, bold, more unabashed and free about their bodies," said Dr. Guy.

Dr. Diana Zuckerman, a psychologist and board member of the National Women's Health Network, does not see implants as a sign of empowerment. In many cases, she said, they reflect an urge to conform to an image of sexiness defined by magazines and lingerie catalogues full of models with implants.

Dr. Cunningham said he expected to see more implant operations as baby boomers work to defy aging.

" 'I'm going to emphasize how young I look,' " he said, describing the attitude. " 'Large breasts show I'm young and vital and full and happy.' I think you will see more of that, like you'll see more men on Harleys."

Not only are more women getting implants, but they want them bigger than ever, said Dr. Joel Rudin, a New York City plastic surgeon who performs two or three breast enlargements per week.

"Women are understandably concerned about appearing that they have breast implants, so they tend to be conservative," he said. "But all too frequently these same women return a year later saying that while they're happy with their implants, they wish they had gone a little bit bigger. And many do decide to make the change."

Few women are neutral on the subject of breast enlargement. Some shudder at the thought of having surgery just to fill a bigger bra, and assume that women who submit to it must lack self-esteem or intelligence. But others see implants as one more means of looking better, albeit a bit more extreme than hair dye, mascara and pierced ears.

Plastic surgery appeals to some people, said Dr. Spear, whereas "another segment would never do it and can't see why anybody else would. The key thing is not to let one group tell the other what they can do." His patients have included doctors, lawyers and judges, he said.

Many women want implants because their breasts shrank and sagged after childbirth.

One, a 31-year-old mother of two young children from Wayne, N.J., who spoke on the condition of anonymity, said she had always been "small-chested," but developed "big, beautiful breasts" during pregnancy and nursing. Once she stopped breastfeeding, though, they became smaller than ever. She wanted the big ones back.

"I felt really depressed," she said. "I felt inadequate when I was intimate with my husband. It was nothing he did. I just didn't feel feminine."

Trying on clothes, especially bathing suits, she thought she looked downright masculine. Once, hoping to look good in a strapless gown, she resorted to using masking tape to try to create cleavage.

Implants took her from an A cup to a C. The operation was more painful than she had expected, and recovery took longer, but she thinks it was worth it. "Our sex life is so much better because I feel so much better about myself," she said. "I feel sexy and I guess my husband picks up on that. I buy sexy lingerie all the time where before I never did." She has even created a Web site (www.implantinfo.com) to help other women get information about implants.

Ms. Voog debated with herself about implants for 10 years before she finally got them. She said that before the surgery, her chest was so flat she had almost no breasts at all. "Clothes sort of just hung on me," she said.

Now her clothes look smashing, she said, but her D-cup anatomy is a bit more than she expected. "I think my surgeon went a little hog wild," she said. "I think I wanted to be a C."

There were other surprises. For a week after the surgery, she was in

such severe pain that moving her arms became difficult, and her boyfriend had to take care of her. Her nipples have normal sensation, but scattered spots on other parts of her breasts are a bit numb. And her breasts do not feel the way she had expected they would. "I thought they would feel natural, and they don't," she said.

"That was a shock. I'm self-conscious when I hug anybody."

Ms. Voog's breasts are round, high and firm looking.

But her nipples are not centered; the implants have left them high and outside.

People respond differently to her appearance. Intellectual men, she said, seem less inclined than before the surgery to take her seriously. Feminists act disdainfully. Men she thinks of as "jocks" have suddenly become more interested in her. Some stare at her chest instead of looking her in the eyes while talking to her. "It's beyond their control," she said. "They become totally dumb, like deer in the headlights."

She printed "YES, THEY'RE FAKE" on her shirt with a marker to attend a party in Manhattan, just to head off questions, smirks and smug remarks. "People are always wondering," Ms. Voog said. "I just wanted to put it out of their minds."




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