The Next Breast Thing

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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 Baywatch breast 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.

The same year Hamas conducted his first study, Tebbetts co-authored and released his book The Best Breast, which handsomely illustrates and extensively details the round vs. anatomic dilemma facing patients. According to its introduction, the book is aimed at "discriminating women" so they might base their augmentation "decisions on facts and knowledge rather than hype and fluff." Although it does provide valuable information--even cautions women that "there is no single type of implant that is best for every patient"--it often reads like a sales pitch for anatomic implants, indoctrinating patients as much as educating them. What is presented as hard scientific fact--if a surgeon fills a round implant to a manufacturer's recommendation, the implant shell will fold and collapse--is based on Tebbetts' clinical opinion.

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Mark Donald
Contact: Mark Donald

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