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“The Big Picture” – Allure Magazine

Article from April 1999 Allure Magazine Article reprinted with permission of its author, Joan Kron

After four children and a glimpse of what gravity had in store for her, one woman chose silicone breast implants. It wasn’t easy.

By Joan Kron

It was barely two weeks after Christmas, and things were just returning to normal. She was awake at 6:30 that morning as usual, glancing occasionally from her pillow toward the TV and the local Oklahoma City news. After nudging her husband out of bed, she went from room to room rousing their four kids. She checked that teeth were brushed and shoelaces were tied – and managed to shower and dress herself. Nothing fancy: leggings and an oversize denim shirt, clothes that would be easy to get in again later that day, after it was over.

She hadn’t eaten since midnight and had been instructed not to eat this morning. But the children lined up on stools at the kitchen bar didn’t notice their mother was skipping breakfast. She fixed an Eggo waffle for one child, toast and cereal for the others, and coffee for her husband, who was taking the day off to be with her. While the kids loaded their backpacks, she loaded the dishwasher. If something were to go wrong today, she didn’t want to be remembered as someone who left dishes in the sink.

Everyone piled into the red Ford Expedition. It was still too early to drop the kids at school, so she’d arrange to leave them with a friend – one of three she had let in on her secret.

“That means the whole world knows,” she jokes now. But she’s hoping her parents never find out: “It made me feel like a schoolgirl, keeping things from Mom and Dad, but they’d be really upset if they knew what their daughter was doing.”

From the friend’s house, she and her husband headed for the operating room used by plastic surgeon Tim R. Love, where she handed over the two sturdy Warner’s bras she’d been told to buy for the occasion – a 34D and a 36D, without underwires – and became part of history.

“It didn’t feel historic,” says Debbie, as we’ll call her, of the breast implant surgery she underwent that morning. The stay-at-home mother was more concerned about ending up too chesty. “When I woke up from the anesthetic,” says Debbie, a size 6, “my first words were, ‘I hope I don’t look like Dolly.’”

Debbie, 41, won’t enter the record books for the size of her implants, which pumped up her bra size from a 34C , which she had trouble filling, to a full 34D. It’s what’s inside the implants that is notable. They are filled with silicone gel. Debbie is the first patient in the United States in seven years to be permitted to receive gel implants simply because she wanted larger breasts. And the future of silicone breast implants may depend on her continued good health. By July, some 500 women around the U.S. will join Debbie in this collective act of faith.

In 1992, after women began blaming their silicone implants for lupus, arthritis, and other autoimmune diseases, the Food and Drug Administration banned silicone-gel implants for cosmetic purposes – until the devices could be proven safe. In the ensuing panic, thousands of women rushed to have their silicone implants removed, and even more joined a class-action lawsuit against the manufacturers that culminated in a $4.25 billion settlement and the bankruptcy of Dow Corning.

During this moratorium, silicone-gel implants have been tightly controlled – available only for three medical conditions: for breast reconstruction in cancer patients after mastectomy; to replace implants that have ruptured or are problematic; and to repair birth defects, such as a sunken chest or misshapen breasts. And the health of anyone receiving these implants has to be tracked. But all that didn’t really bother Debbie.

“I’ve always been attractive and had a good body,” she says. “When you’re young, you don’t think your body will change. I never thought about implants. After four kids, I still looked good, but when I turned 40, things started going.” Swimsuit shopping clinched it. “I began to realize I didn’t look the same anymore. I was losing fullness. I couldn’t fill out my bra.”

She blames it on breast-feeding. Push-up bras helped, but “when I was out of my clothes, it bothered me,” she says. What she really wanted was natural fullness – or at least natural-looking fullness. A friend of hers had gotten implants, and Debbie thought they looked good. “I wanted restoration. You put new tires on a car – why not maintain our bodies if we have that option?”

For almost a decade, women like Debbie who just wanted to look better in a bra or bathing suit had no alternative but saline implants – which are actually silicone shells filled with salt water. Saline implants, though, are no panacea. They can leak, deflate, and rupture. Unless the patient has a great deal of breast tissue, the outline of the implant often can be seen, and the skin covering the implant can ripple like a flaccid water balloon. And just as with silicone implants, the body quickly forms a capsule of scar tissue around the foreign implant that may contract, becoming hard and painful.

Whatever the risks, women have been willing to take them. There are 120,000 implant operations performed each year, as many as there were before the implant crisis began. And the numbers are rising. Four out of five implant patients simply want bigger breasts.

“Most breast-implant candidates don’t want to be in your face or push your eyeballs out,” says Los Angeles plastic surgeon Barbara Hayden. “They are usually very intelligent women, but time or pregnancy has made them self-conscious about their drooping breasts.”

When Debbie first consulted Tim Love, in November, “I just assumed I would have saline. Without a doubt,” she says. “I felt it was salt water, not foreign to the body. If you had a leakage, you wouldn’t worry about it being a problem. I didn’t realize the container was silicone.” But later, Love informed her that silicone gel was an option and that medical trials of the implants were about to being.

Love was 1 of 24 doctors participating in the first study, run by McGhan Medical, the implant manufacturer. A small number of women who wanted cosmetic augmentation would be allowed to have silicone, on one condition: they had to agree to return to their doctor for checkups, MRIs (for some of the women), and quality-of-life questionnaires regularly for the next ten years.

“We talked quite a bit about the silicone issue,” says Debbie. Love showed the couple the results of several large-scale studies that found virtually no connection between autoimmune diseases and implants – findings confirmed two weeks later by a panel of experts appointed by the judge in the class-action lawsuit. Love didn’t discourage Debbie from saline. He told her she had enough tissue to cover a saline implant. It was her choice. Debbie didn’t need to think it over. She chose silicone because “it is more natural-looking and –feeling than saline.” And she knew a woman with saline implants who told her she would have preferred silicone. Debbie’s husband agreed with the choice. Still, she worries.

The disease she fears most is cancer. She felt better when Love pointed out that there wasn’t a higher incidence of cancer with implants.

“I wanted to make sure I could have mammograms and they could be read,” she says. That’s why she elected to have the implants under the muscle, where they don’t interfere with X rays. “I would be more apprehensive if I weren’t part of a study,” Debbie admits.

Once she made her decision, she says, she did worry about how long she would be out of commission. And what the scar would be like. The few friends who knew made subtle attempts to dissuade her. One was a nurse. “She warned me about anesthetic,” recalls Debbie, “and told me about women who come into the ER with big, hard breasts.” On the day before surgery, Debbie was surprised to learn that she was patient zero. And that surgery could not proceed until she had read all the informed-consent documents and answered pages of questions about her physical and mental health and expectations.

“We were under the gun to get these government forms filled out,” she says. The results of the study will help the FDA decide whether, once again, Americans can get silicone-gel implants from any doctor for any reason – without special permission.

After the surgery, Debbie was home in bed and pretending to have the flu by the time her children got home from school. “I had less pain than I anticipate,” she says, but she admits she had a month of anxiety till she got used to her new breasts. “At first I thought, ‘Oh, they’re huge.’ And they were really hard. It took two weeks for them to feel soft. It was painful to lie flat. When you flex a chest muscle, the implant will move and it’s a weird feeling,” she says. “It still feels kind of odd and uncomfortable to lift the hatchback on my car, but it’s getting better.”

It was an adjustment for her husband too, she says. “A week after surgery, I said to him, ‘You haven’t commented much.’ He said, ‘I don’t think you needed the surgery.’ That destroyed me.”

The ugly postsurgery support bras weren’t helping. After her one-month checkup, Debbie decided she needed to shop. Her husband was taking her to Las Vegas to celebrate, away from the kids.

“That was my coming-out party,” she says. “We went to a Victoria’s Secret there the first day and bought three bras. I had to buy a double-D because I was still swollen. The girl behind the counter asked me how I felt about being a double-D. She said she thought the perfect cup size would be a C. I told her, ‘I don’t have a problem with it.’” Nor does her husband. He finally admitted, ‘You really look good. You look like you used to look,’” says Debbie, who is relieved to report – five weeks after surgery – that the implants “don’t feel foreign anymore. I can’t tell you where the implant stops and I start. It feels really natural.”

She admits, with a touch of embarrassment, to a new fascination with her body. “I look in the mirror more now,” she says. Part of her newfound confidence is knowing that as part of a study, she has a doctor who is as interested in her well being as she is. “ I don’t want to take health risks,” she says. “I hope I haven’t done something that will hurt me later.”