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One of them is Dr. Robert Hamas, a local physician who has conducted his own studies, which he contends prove that once they are placed inside the body there is no physical difference between round and anatomic implants. His research has encouraged Dallas attorney Marc Stanley to file a class-action lawsuit against McGhan on behalf of Jameson and several hundred thousand similarly implanted women because of the company's allegedly false advertising. It helped inform the FDA when the agency insisted that McGhan cease its advertising campaign because it could not prove its claims of naturalness. What's more, it has incited a war of recrimination between Tebbetts and Hamas that has become decidedly personal, though neither man is a party to the lawsuit.
"You're dealing with two strong-willed Texans competing in a hotbed of plastic surgery," says respected Arizona plastic surgeon Boyd Burkhardt, who has served as an adviser to the FDA on implant-related issues. "You can't completely divorce their personalities from their science."
John Tebbetts wasn't the first plastic surgeon seeking to build a better breast. Early attempts at enhancement by doctors began around the turn of the century, first with the direct injection of paraffin into the breast, then with fat-tissue transplants and later with the insertion of the plastic sponge. Liquid silicone developed a grassroots following after World War II, injected into the breast by Japanese prostitutes looking for repeat business from American servicemen. The practice caught on with Las Vegas showgirls, strippers and unconventional doctors who were also looking for repeat business and were willing to risk silicone's possible side effects: infection, disfigurement and migration into the internal organs.
If only there were a way to contain silicone within a bag or shell, then the chance of it leaking into the rest of the body would be minimized. In the early '60s, Houston plastic surgeons Thomas Cronin and Frank Gerow worked with the Dow Corning Corp. to develop a rubbery silicone outer shell, which was filled with a gel-like silicone liquid. "Their first implants were actually teardrop-shaped," says Houston plastic surgeon Thomas Biggs, who did his residency under Cronin and later became his partner. "Then a New York surgeon told us that the breast is not teardrop, it's actually round. So we made them round."
In 1968, Dr. Henry Jenny, a California plastic surgeon, designed the first saline implant, which was little more than an inflated water balloon. But doctors and patients found saline too squishy and unnatural, preferring the softer, more breastlike feel of silicone gel. The '70s and '80s saw demand for silicone implants soar, as plastic surgeons, implant manufacturers and the media promoted implants as a quick fix for low self-esteem, a safe way to attain a quality of life women might never realize if they remained forever flat-chested.
"Plastic surgeons co-opted the language of psychology," says Lithe Sebesta, co-author of The Breast Book, which will be released in May. "They have taken words like inferiority complex and applied it to small-breasted women, even calling it a disease--micromastia--which basically means small-breasted women who have a complex about it." In a 1982 petition before the FDA, the American Association of Plastic and Reconstructive Surgeons (now the American Society of Plastic Surgeons, ASPS) maintained that small breasts "are really a disease, which in most patients results in feelings of inadequacy, lack of self-confidence...and a lack of well-being due to a lack of self-perceived femininity." They offered a cure for this disease: "the enlargement of the underdeveloped breast."
It would seem that feminists would rail against the implants, seeing them as an implement of male oppression, much like they did the bra and fashion trends in general. And they did, for a time. But with reconstructive surgery offering to make breast cancer survivors whole again, and the '60s demand for social equality giving way to the '80s demand for personal empowerment, any feminist outrage toward implants seemed muted at best, particularly since more and more women came away from their breast enlargements with an enhanced feeling of self-worth. The ASPS claims that more than 90 percent of the women who undergo breast augmentation are satisfied customers. "There are legitimate connections between physical image and psychological image," says author Sebesta. "Although plastic surgeons have pushed this connection too hard."
"This operation makes happy ladies," Dr. Biggs says. "It's an operation that beautifully fits the average American woman."
Texas women seem particularly charmed by its cosmetic benefits. Not only does this state rank high in the number of cosmetic surgeries performed (along with Florida and California), but its women request larger breasts more frequently than their East Coast counterparts. "For a region to be a cosmetic capital, it has to have money, because it's an elective surgery and you are paying out of pocket," explains California psychologist Barbara Nash, author of What Your Doctor Didn't Tell You About Plastic Surgery. "The culture probably has to have a large investment in image and body appearance, and a warm climate where you can show off that appearance."
It also helps that Dallas has a deep pool of talented plastic surgeons who are adept at performing what amounts to a fairly simple procedure. After the patient receives a general anesthetic, the surgeon makes an incision in one of three places: in the fold of the breast, in the armpit, around the areola. To position the implant, he creates a pocket, either over the muscle separating the breast tissue from the ribs or partially behind the muscle. Either way, the surgeon centers the implant behind the nipple and then inflates the implant with saline. Silicone-gel implants are prefilled.
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