By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
By Eric Nicholson
Tebbetts says he did not recommend any specific type of implant. "Like all our patients, she was offered a choice of any type of implant she desired, by any manufacturer she desired." She was also given information about shell folding issues, he says, "and she personally selected the implant she received."
Not surprisingly, she chose the anatomic, wanting it placed over the muscle rather than under (quicker recovery), wanting it textured rather than smooth (less chance of implant movement). Things went so well with her surgery, Tebbetts asked her to speak with a reticent patient and allay her concerns. She would later be glad she refused.
For the next three weeks, she felt fine, believing what she had been told, that she had a more natural look. Then one morning while in bed, she reached for a glass of water, heard a pop inside her chest and felt a sharp, shooting pain. She phoned Tebbetts' office and learned he was out of town. His staff thought she was hemorrhaging--a risk that had nothing to do with the shape of the implant and one that Tebbetts now says "was an exceedingly unusual occurrence" that might have been caused by "something other than surgery." Immediately her chest swelled and she called an ambulance. At Baylor Hospital, another doctor on call for Tebbetts performed a second surgery and stopped the bleeding.
By the time she saw Tebbetts, she was quite emotional, demanding he pay for the second surgery, which he did. She found him overly hurried and uncomfortable with her complaints. He quickly brought in his "patient educator"--his wife--who calmed her down. But her complications didn't end there. The upper portion of her left breast had grown hard and sore because of capsular contracture, which might have been caused or worsened by the hemorrhaging. But she had no intention of returning to Tebbetts--too unmannerly, she says--and she made an appointment with Dallas plastic surgeon Robert Hamas.
Hamas and Tebbetts had entered private practice in the same year, working as young associates in the same Dallas office. At least one plastic surgeon speculates that their early relationship might be the source of professional jealousy between them, although Hamas denies that's the case. Jameson knew about Hamas from a girlfriend who had come away from his scalpel with remarkably large breasts, which is why she didn't use him in the first place. Hamas recommended that Jameson undergo a second surgery to clear away her scar tissue, but she refused, unwilling to let anyone else cut her. After Hamas learned her implants were anatomic, she agreed to let him X-ray her, both standing up and lying down. Then he compared her X-rays with those of a woman with round implants. "I could see there was no anatomical difference between round and teardrop," she says. "And I wanted my money back."
Hamas told her about the research he had conducted, supposedly debunking the anatomical differences between round and teardrop implants. After X-raying 14 round implant patients and 12 anatomic, he concluded that while an anatomic implant might look different outside the body, there was essentially no difference between the two once placed inside the body. When a woman is standing upright, gravity causes either implant to assume a teardrop shape. And in a recumbent position, Hamas claims, the round implant behaves more anatomically than the anatomic, spreading out more uniformly like a natural breast.
In May 1999, Hamas presented his findings during the American Society for Aesthetic Plastic Surgeons meeting in Dallas and received a standing ovation, an unusual response at a medical forum. Hamas believes he tapped into something that had been bothering many surgeons: the manipulation they felt by McGhan's advertising campaign. "It was extremely well-crafted," he says. "Patients would walk in with the ad in their hands and say, 'I want the natural one.' Well, then, who's going to give them the unnatural one?"
Despite their patients' wishes, some doctors resisted using anatomic implants, convinced they were no more than a pricey marketing ploy. "The body dictates the shape of the implant, not the implant the shape of the body," says Dr. Melmed. "I could probably put a square implant in there and it would be the same."
What seemed disingenuous about the McGhan campaign was that it appeared to lay the problem of bulging augmented breasts squarely on round implants. But the globular Baywatchbreast is just as likely the result of capsular contracture, a natural bodily reaction beyond the surgeon's control. Dr. Tebbetts himself believes there are more than 50 factors that influence the shape of the breast after augmentation; so why all the fuss over just one of them--the shape of an implant?
McGhan, however, didn't take Hamas' presentation lightly. In June 1999, the company sent a letter to all those doctors who attended the Dallas meeting, questioning the scientific soundness of Hamas' conclusions. Undaunted, Hamas conducted a second study partly to defend his first, but that didn't stop Tebbetts from registering his own objections in a respected plastic surgery journal. He accused Hamas of "ignoring and omitting data," of experimenting on humans without proper guidelines or informed consent, of not using a "qualified radiologist" and having "no personal clinical experience" with anatomic saline implants.
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