COSMETIC SURGERY: CANCER AND OTHER “VARIATIONS FROM THE IDEAL”
Starting in 1983, the American Society of Plastic and Reconstructive Surgeons launched a “practice enhancement” campaign, issuing a flood of press releases, “pre-and post-op photos,” and patient “education” brochures and videotapes. They billed “body sculpturing” as safe, effective, affordable—and even essential to women’s mental health. “There is a body of medical information that these deformities [small breasts] are really a disease,” a statement issued by the society asserted; left un-corrected, flat-chestedness causes “a total lack of well-being.” To fight this grave mental health hazard, the society was soon offering a financing plan for consumers—“no down payment” and credit approval within twenty-four hours.
The inspiration for the society’s PR blitzkrieg was the usual one—a little problem with supply and demand. While the ranks of plastic surgeons had quintupled since the 1960s, patient enthusiasm hadn’t kept pace. By 1981, the flood of doctors into cosmetic surgery had made it the fastest-growing specialty in American medicine, and they simply needed more bodies. Plastic surgeons started seeking publicity in a systematic way. By the mid-’80s, their appeals overran magazines and newspapers, offering “low monthly payment plans,” acceptance of all credit cards, convenient evening and Saturday surgery sessions. A single issue of Los Angeles magazine contained more than two dozen such ads.
The surgeons marketed their services as self-image enhancers for women—and as strategies for expanding women’s opportunities. Cosmetic surgery can even help women “pursue career goals,” an ad in the New York Times promised. With liposuction, “you can feel more confident about yourself,” the Center for Aesthetic & Reconstructive Surgery said. “Most important,” you can exercise a “choice”—although by that, the ad copy referred only to “your choice of physician.”
From Vogue to Time, the media assisted the doctors, producing dozens of stories urging women to “invest,” as a Wall Street Journal article put it, in breast expansion and liposuction. “Go curvy,” Mademoiselle exhorted. “Add a bit above the waist;” it’s easy and you can “go back to work in five days, and to aerobics in six weeks.” “Attention, front and center!” the magazine demanded again, three issues later. “The lush bust is back”—and breast implants are the ideal way of “getting a boost.” A feature in Ladies’ Home Journal lauded three generations of women in one family who have “taken control” of their appearances by taking to the operating table: grandmother had a $5,000 face-lift, mother a $3,000 breast implant (after her husband admitted that the idea of big breasts “would indeed be exciting”), and daughter a $4,000 nose job. “I decided that feeling good about my body was worth the risk,” the mother explained. TV talk shows conducted contests for free cosmetic surgery; radio stations gave away breast implants as promotions. Even Ms. deemed plastic surgery a way of “reinventing” yourself—a strategy for women who “dare to take control of their lives.”
Soon, the propaganda circle was complete: cosmetic surgeons clipped these articles and added them to their resumes and advertisements, as if media publicity were proof of their own professional excellence. “Dr. Gaynor is often called ‘the King of Liposuction,’” an ad for dermatologist Dr. Alan Gaynor boasted. “He has appeared as a liposuction expert on TV dozens of times, as well as in Time magazine and the Wall Street Journal, and most local newspapers.”
The campaign worked. By 1988, the cosmetic surgeons’ caseload had more than doubled, to 750,000 annually. And that was counting only the doctors certified in plastic surgery; the total annual figure was estimated in excess of 1.5 million. More than two million women, or one in sixty, were sporting the $2,000 to $4,000 breast implants—making breast enlargement the most common cosmetic operation. More than a hundred thousand had undergone the $4,000-plus liposuction surgery, a procedure that was unknown a decade ago. (By 1987, the average plastic surgeon cleared a profit of $180,000 a year.) About 85 percent of the patients were women—and they weren’t spoiled dowagers. A 1987 survey by a plastic surgery association found that about half their patients made less than $25,000 a year; these women took out loans and even mortgaged homes to pay the surgery bill.
Publicity, not breakthroughs in medical technology, had made all the difference. Plastic surgery was as dangerous as ever; in fact, the operations would become even riskier as the big profits lured droves of untrained practitioners from other specialties. In 1988, a congressional investigation turned up widespread charlatanry, ill-equipped facilities, major injuries, and even deaths from botched operations. Other studies found that at least 15 percent of cosmetic surgery caused hemorrhages, facial nerve damage, bad scars, or complications from anesthesia. Follow-up operations to correct mistakes filled a two-volume, 1,134-page reference manual, The Unfortunate Result in Plastic Surgery. Plastic surgeons were devoting as much as a quarter of their practices to correcting their colleagues’ errors.
For breast implants, in at least 20 percent of the cases, repeat surgery was required to remedy the ensuing pain, infection, blood clots, or implant ruptures. A 1987 study in the Annals of Plastic Surgery reported that the implants failed as much as 50 percent of the time and had to be removed. In 1988, investigators at the FDA’s Product Surveillance division found that the failure rate of breast implants was among the highest of any surgery-related procedure under their purview. But rather than take action, the FDA stopped monitoring failure rates altogether—because consulting doctors couldn’t decide what constituted “failure.”
Contracture of scar tissue around the implant, separation from the breast tissue, and painful hardening of the breasts occurred in one-third of women who had the operation. The medical literature reported that 75 percent of women had some degree of contracture, 20 percent of it severe. Implants also caused scarring, infection, skin necrosis, and blood clots. And if the implants ruptured, the leaking could cause toxicity, lupus, rheumatoid arthritis, and autoimmune diseases such as scleroderma. The implants also could interfere with nursing, prevent cancer detection, and numb sensitivity. In 1989, a Florida woman died during breast enlargement surgery. While the cause, an overdose of anesthesia, was only indirectly related to the procedure, it’s still fair to describe her as a backlash victim: a model with two children, she had the operation because the modeling agencies were demanding women with big breasts.
In 1982, the FDA declared breast implants “a potentially unreasonable risk of injury.” Yet the federal agency did not pursue further research. And when a 1988 study by Dow Corning Corporation found that silicone gel implants caused cancer in more than 23 percent of rats tested, the FDA dismissed the findings. “The risk to humans, if it exists at all, would be low,” FDA commissioner Dr. Frank Young said. Not until April 1991, after still more federal research linking foam-coated implants to cancer surfaced and after a congressional subcommittee intervened, did the FDA finally break down and give the implant manufacturers ninety days to demonstrate that their devices were safe or take them off the market. A nervous Bristol-Myers Squibb Co. wasted no time yanking its two brands from the shelves.
To these problems, the American Society of Plastic and Reconstructive Surgeons responded with a “position statement,” written as a press release, which offered “reassurance to the nearly 101,000 women who undergo breast enlargement every year.” Women with breast implants “are at no increased risk of delayed cancer diagnosis,” the statement soothed, without offering any medical evidence to back its claim. It did, however, propose that “the real causes of late diagnosis are ignorance, complacency, neglect, and denial.” In other words, the woman’s fault.
The track record of liposuction, the scraping and vacuuming of fat deposits, was no better. Between 1984 and 1986, the number of liposuction operations rose 78 percent—but the procedure barely worked. Liposuction removed only one to two pounds of fat, had no mitigating effect on the unseemly “dimpling” effect of cellulite, and, in fact, often made it worse. The procedure also
could produce permanent bagginess in the skin and edema, just two of the “variations from the ideal” that the plastic surgery society cataloged in its own report. Another “variation” on the list: “pain.”
Furthermore, the plastic surgery society’s survey of its members turned up several other unfortunate incidents. A liposuction patient lay down to have stomach fat removed and woke up with a perforated bowel and fecal matter leaking through the abdominal cavity. Three patients developed pulmonary infections and two had massive infections. Three suffered pulmonary fat embolism syndrome, a life-threatening condition in which fat can lodge in the heart, lungs, and eyes. And “numerous patients” required, as the survey delicately put it, “unplanned transfusions.”
On March 30, 1987, Patsy Howell died of massive infections three days after a liposuction operation performed by Dr. Hugo Ramirez, a gynecologist who ran a plastic surgery clinic in Pasadena, Texas. The same day Howell had her operation, Ramirez performed liposuction on Patricia Rogers; she also developed massive infections, was hospitalized in critical condition, and eventually had to have all her skin from below her chest to the top of her thighs removed.
Howell, a thirty-nine-year-old floral shop manager and the mother of two sons, submitted to liposuction to remove a small paunch on her five-foot-one frame. She weighed only 120 pounds. “This literature she got at a shopping mall said the procedure was so simple,” her friend Rheba Downey told a reporter. “She said, ‘Why not?’” She made up her mind after reading Ramirez’s newspaper ad, calling the surgery “the revolutionary technique for reduction of fat without dieting.” No one told her about the dangers. Ramirez operated on more than two hundred women, causing numerous injuries and two deaths before his license was finally revoked.
By 1987, only five years after the fat-scraping technique was introduced in the United States, the plastic surgery society had counted eleven deaths from liposuction. A 1988 congressional subcommittee placed the death toll at twenty. And the figure is probably higher, because patients’ families are often reluctant to report that the cause of death is this “vanity” procedure. A woman in San Francisco, for example, who was not on the surgery society’s or Congress’s list, died in 1989 from an infection caused by liposuction to her stomach; the infection spread to her brain, her lungs collapsed, and she finally had a massive stroke. But her family was too ashamed about the procedure to bring it to public attention.
The society’s 1987 report on liposuction, however, seemed less concerned with safety than with “the reputation of suction lipectomy,” which its authors feared had been “marred by avoidable deaths and preventable complications.” It concluded that all problems with liposuction could be easily solved with “guidelines governing who is permitted to perform and advertise surgical procedures.” In other words, just get rid of the gynecologists and dermatologists and leave the surgery to them.
Yet some of the liposuction patients had died at the hands of plastic surgeons. And the most common cause of death was the release of fat emboli into the heart, lungs, and brain—a risk whenever inner layers of epidermis are scraped, no matter how proficient the scraper. As even the report acknowledged: “[Liposuction] is by its nature a tissue-crush phenomenon. Therefore, fat embolism is a realistic possibility.”
Surgeons also marketed the injection of liquid silicone straight into the face. Vogue described it this way: “Plastic surgery used to be a dramatic process, but new techniques now allow doctors to make smaller, sculptural facial changes.” This “new” technique was actually an old practice that had been used by doctors in the last backlash era to expand breasts—and abandoned as too dangerous. It was no better the second time around; thousands of women who tried it developed severe facial pain, numbing, ulcerations, and hideous deformities. One Los Angeles plastic surgeon, Dr. Jack Startz, devastated the faces of hundreds of the two thousand women he injected with liquid silicone. He later committed suicide.
For the most part, these doctors were not operating on women who might actually benefit from plastic surgery. In fact, the number of reconstructive operations to aid burn victims and breast cancer patients declined in the late ’80s. For many plastic surgeons, helping to boost women’s self-esteem wasn’t the main appeal of their profession. Despite the ads, the doctors were less interested in improving their patients’ sense of “control” than they were in improving their own control over their patients. “To me,” said plastic surgeon Kurt Wagner, who operated on his wife’s physique nine times, “surgery is like being in the arena where decisions are made and no one can tell me what to do.” Women under anesthesia don’t talk back.
THE MAKEOVER OF THE 5 PERCENT WOMAN
Diana Doe, a single working woman, had much to be proud of by the time she reached her thirty-fifth birthday. (“Diana Doe” is a pseudonym. The woman originally agreed to have her name used and actively sought media attention. Her story and name have been published in other news accounts and aired in a TV news program. But that publicity led to such an outpouring of verbal abuse and mockery that the woman retreated in shame. She has asked that her name not be mentioned here.) She had published three children’s books; she was running several workshops to improve children’s speech and self-esteem; she had a dozen different free-lance writing projects in the works; and she had just been asked to teach gifted students for a program sponsored by a top university. Yet, as she stood in the supermarket checkout line on a hot June day in 1986, idly inspecting the magazine rack, she felt a chill of humiliation pass through her body. She was looking at the Newsweek cover story, which notified her that her chances at marriage had just fallen to 5 percent. “I just felt sick. I told myself, Okay, [Diana], get ahold of yourself. This is not like getting cancer.” She went home and put the statistic out of her mind.
A few weeks later, she was on the phone with a male reporter at a fitness magazine, trying to set up another free-lance assignment. “So did you see that story in Newsweek?” she recalls him asking her. “You might as well forget it; you’re never going to get married.” Why? she asked. “Women in their thirties are physically inferior,” he said. “It’s just a reality.” She told him that she had every intention of marrying, and besides, “Women in their thirties have a lot more to offer than you are giving them credit for.”
“Are you really convinced of that?” he asked. “Because if you are, then you wouldn’t mind putting a little money on the deal.” By the time they hung up, Diana had bet him nearly $1,000 that she would “beat the five percent odds” and be married by forty. The journalist was also single, and thirty-eight years old, but somehow it never occurred to either of them to make a wager on his marital future.
Diana said she took him up on the bet because she wanted to show him “what a woman at my age is capable of achieving.” She said, “I really believe that women in their thirties are evolving in the 1980s.” But pretty soon, she was diverting all those capabilities to the “evolution” of her physique. Her story is one of the more extreme illustrations of how thoroughly backlash ends had harnessed feminist means—and how destructive the consequences could be when liberation rhetoric got mixed up in individual women’s minds with cultural signals that were meant to undermine, not improve, their confidence and sense of self-worth.
Tall, with angular cheekbones and big eyes, Diana had, in fact, worked briefly as a model in her twenties. But with age, she believed, her body had not stood the test of time and could “stand some improvement;” her physical deficits, she became convinced, stood between her and the marriage altar. Her anxiety over her appearance was only heightened after she consulted a modeling expert, who “told me that I should divide my body up into parts and go over each part with a magnifying glass,” Diana recalls. “The parts that I could improve on, I should go ahead and work on. The rest, I should try to cover up.”
After reviewing her body inch by inch, she concluded it needed a complete overhaul. Having read all the stories on the miracles of plastic surgery, she figured that was
the most efficient way of executing her transformation, or “defining a woman’s new options and opportunities in the ’80s,” as she put it. She even settled on her final measurements: 37—25—37. The only question was how to pay for it. A seasoned freelance entrepreneur with a self-professed taste for “dealmaking,” Diana had always been adept at pulling together financing for her professional projects; now she redirected that same talent to rearranging her body. Diana’s strategy might recall that of the avenging housewife in Fay Weldon’s popular 1983 novel, The Life and Loves of a She-Devil. But Weldon’s heroine retooled her body to triumph over her philandering husband; Diana Doe was changing her body only to comply with male wishes and please a potential mate.
With a marketing plan in mind, Diana tracked down Patrick Netter, Hollywood personal-fitness trainer. Turning back the clock on her body could be a “great media story,” she told him. “It’s a story about a woman realizing her own potential. It’s a Cinderella story for the ’80s.” She wielded a profit analysis she had personally commissioned from a marketing professor. (He computed that selling her metamorphosis could generate “anywhere from $101,000 to a half-million dollars.”) She even had a handle for her new self: “the Ultimate 5 Percent Woman.” And Netter could have a piece of the action. He could be her personal manager, she proposed, and locate health-care and cosmetics companies that would be interested in financing her transformation in return for free publicity. “I thought her idea of promoting her metamorphosis made commercial sense,” Netter says later. “It’s a little sad that a woman has to do that.” But not so sad that it stopped him from drawing up a contract—guaranteeing himself 50 percent of the profits.
A few weeks later “the Project,” as Diana called it, was officially launched. An L.A. television infotainment show filmed a segment on her makeover. And Netter set her up with a plastic surgeon, who agreed to perform $20,000 worth of plastic surgery on her at no charge: facelift and-peel, eyelid lifts on both top and bottom lids, a nose job, a breast augmentation operation, a tummy tuck, and liposuction on her hips and thighs. In exchange, she would mention his name in radio and television shows—with the guarantee that, as Netter puts it, the publicity would be “favorable” and “in good taste.” Diana struck similar deals with a Los Angeles dentist, a health club, a beauty spa, and a wardrobe consultant. She also contracted with a fitness magazine to write ten articles about her evolution. Later, she hired a literary agent to sell her fourth book, the story of her physical renovation, entitled Create Yourself.