Longform

The Next Breast Thing

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After one FDA hearing, Dr. John Tebbetts, a Dallas plastic surgeon, grabbed the national media spotlight, briefly appearing on ABC's World News Tonight. While contending the FDA should not ban silicone implants because their saline substitutes do not look as natural, he added, "You have committed patients to a breast that is far from normal, compared to a gel-filled implant."

What he didn't say was that he had already begun his quest for an implant that would present a more natural-looking breast: the anatomic.


In Tebbetts' Oak Lawn medical offices, subtle suggestions are at work: the mauve and lavender walls that soothe the anxious and ease the uncertain; the sculptures and paintings of swans that hint at a transformation from ugly duckling; copies of The Best Breast, which intimate that its author is the best person to deliver the best breast.

And then enters Tebbetts, who instantly diffuses this air of subtlety with his blustery, East Texas country-boy demeanor. At 55, he's a likable cuss, a no-nonsense, tough-talking, opinionated man who tends to dominate the conversation. His hunger to be challenged is evident from the array of photos in his inner office that show him dirt-biking and tarpon-fishing. He inspires strong feelings from his colleagues, who describe him with a mix of guarded admiration and disdain. They find him a bright, innovative surgeon who aggressively promotes his own innovations: "He is as skillful on the breast as anyone in the world." "He's the Jesse Ventura of plastic surgery." "John is widely regarded as being very enthusiastic about his own ideas."

And Tebbetts is full of big ideas. In addition to designing new implants, he has developed new surgical tools and breast-augmentation procedures that minimize tissue damage and hasten recovery. Ninety-five percent of his implant patients, he says, are back to normal activity within 24 hours. He is largely credited as the first plastic surgeon to publicly condemn the fashion of bigger-is-better by advising patients and colleagues that the too-large breast will ultimately sag, whether augmented or not. He is a strong advocate for patient education, insisting his patients read his book before they consult with him. His résumé lists more than 150 scientific publications and presentations that have published his work, though he is criticized for being overly verbose and unnecessarily complex in his writings.

He claims it was never his goal to build a more natural-looking breast. "That's a total misconception. I had been making perfectly natural breasts since 1979 [the year he entered private practice]."

When McGhan Medical Corp. approached him about designing a new implant in the early '90s, he had already been working with another implant manufacturer, researching whether implant rupture might be caused by folds and wrinkling in the implant's shell. After that manufacturer went out of business, he continued his work with McGhan. "Every bioengineer at an implant manufacturer told me that shell folding was one of the main reasons for shell failure," he says. "So how do you make the shell not fold? You put in more fill [either saline or silicone gel]." And the more you put in, the firmer it gets, the less chance the upper shell will fold or wrinkle when its fill decreases as the lower shell inevitably stretches and sags over time--or so surmised Tebbetts. With a fuller, firmer implant, there would be less chance of leaks, rupture and reoperation, all problems that the FDA had been concerned about.

He experimented with round saline-filled implants, he says, but the more they were filled "the more globular the breasts looked, like a softball." That's when he hit upon the idea of changing the shell's shape, "tapering the top of the shell so we could still put in enough [fill], but not have that excessive upper bulge," he says. "And that's how we did it." Tebbetts soft-pedals the aesthetics of his implant design, instead choosing to tout its safety features. "It's not an issue of the most natural breast. It's the most natural breast in conjunction with minimal shell folding."

McGhan, however, didn't see it the same way, at least not in its national ad campaign. When it brought the anatomic to market in the mid-'90s, it didn't promote the implant's longer shell life or wrinkle minimization to the readers of Glamour or Vogue. Instead, it introduced the Style 468 saline-filled implants as "Perfectly Natural...an anatomic design that reflects the shape of the natural breast." The manufacturer appeared to be playing off fears of women worried about buying a Baywatch boob, those that looked too round, high and obviously fake. "So, we designed our anatomical implant to be more like a woman's breast, "with a gentle slope and a more voluptuous, natural shape," one print advertisement claimed. Illustrations showing grapefruit vs. teardrop shapes accompanied the copy, which hailed the Style 468 as "revolutionary."

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Mark Donald
Contact: Mark Donald

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