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  • Big and Beautiful: The complex questions raised by cosmetic surgery

Big and Beautiful: The complex questions raised by cosmetic surgery

Anna Nicole Smith's tale is reflective of contradictory messages about female body size.

By Peter Osin (Consultant Histopathologist / Cytopathologist at the Royal Marsden Hospital)

3 September 2014 at 2.24pm | Comment on this article

It's hardly surprising that our media send contradictory messages about female body size: they reflect a general confusion in society. What is surprising, perhaps, is that scientific research into the matter, which we might expect to be calmer and more clear-headed, can cloud the issue with equal gusto.

Curvaceousness is controlled by female sex hormones, and has been shown as an important factor in determining female attractiveness across Western society. Interestingly, women with large breasts and narrow waists have a distinct physiological profile, which includes a significantly increased concentration of hormones determining the probability of conception. The hourglass shape therefore serves as cue of fecundity and health to prospective partners.

But, if large breasts offer evolutionary benefits, what can science tell those not blessed with a prominent upper-frontal superstructure about the possibility of scaling higher up the Darwinian ladder? Can they alter their chances?

Perhaps the first thing would be to think again. There are plenty of negatives to having large breasts, ranging from biomechanical difficulties (when the weight of large breasts adversely affects one’s posture and causes back problems) to links with the more aggressive types of breast cancer (currently unexplained).

Despite the numerous potential problems, the male perception of larger breasts as a sign of attractiveness in Western society has led to perpetual attempts by women to increase their bust size.

In the 20th century, the ever-increasing sophistication of surgical techniques and the manufacture of new materials led to some brave early experiments. The earliest, in 1899, used such mineral oils as vaseline and paraffin – yes, paraffin – as a body defect filler. Unfortunately, negative side effects began to appear. Once injected, paraffin often tended to disperse within the body and cause the formation of secondary deposits: so-called ‘paraffinomas’. These were lumps which could pop up almost anywhere, and which were virtually impossible to remove.

The next big step in breast augmentation was the development of silicone implants. Very few medical devices have had their safety tested so extensively or created so much controversy as silicone (now used in plastic bags, but initially injected directly into the tissue). After much investigation, there is currently no convincing evidence linking breast implants to an increased risk of breast cancer, connective tissue disease, offspring effects or neurological disorder. But the risks of local complications (infection, rupture of the implant and painful capsule contraction) still exist. And the negative effects of breast augmentation surgery on the lactating potential of the implantee have never been disputed.

The psychological aspects of cosmetic breast surgery have been the subject of scientific interest for nearly half a century. The most dramatic statistic was the two-to-threefold increase of suicide rates compared to the general population. Naturally, it raised a worrying and disturbing question about the cosmetic surgery itself being a predisposing factor for suicide.

However, all the studies which reported an increased suicide risk among breast augmentation patients compared these women with the general population. But an in-depth look into the demographics demonstrated that implantees are in fact quite different: they tend to display more common alcohol and tobacco use, they have more numerous sexual partners and higher divorce rates and they are more likely to be receiving psychotherapy. Based on these criteria, one could expect to see a five-fold increase in the suicide rate among this group, rather than two to three times – and so it could be argued that the augmentation actually reduces the suicide risk.

So where does that leave us? There are no easy answers to the moral, sexual or psychological questions raised by cosmetic breast surgery – but in Anna Nicole we have what is (probably) opera’s first attempt to address them.

This is an extract from Peter Osin's article 'Big and Beautiful' in the Royal Opera's programme book for Anna Nicole, available during performances and from the ROH Shop.

Anna Nicole runs 11–24 September 2014. Tickets are still available.The first performance is a student-only production with tickets priced £1–£25. Find out more about ROH Students. ROH Students is generously made possible by the Bunting Family and Simon Robey.

By Peter Osin (Consultant Histopathologist / Cytopathologist at the Royal Marsden Hospital)

3 September 2014 at 2.24pm

This article has been categorised Opera and tagged anna nicole, back problems, breast augmentation, breast enlargement, bust size, by Richard Jones, controversy, cosmetic surgery, drug abuse, hourglass, paraffinoma, Production, suicide rates

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