48 REASONS NOT TO GET A BOOB JOB:

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1) According to the National Institute of Medicine, 25 to 40 percent of people who get breast implants end up needing another operation to correct something wrong with the first one. (The rate varied in particular studies, depending on things like how long women were monitored, the typical time being five years.)

2) A study by a maker of saline breast implants, Mentor, found that 27 percent of implants put into breast cancer patients had to be taken back out again within three years, due to side effects. Another 13 percent had to have lesser corrective surgeries. The competing manufacturer McGhan/Inamed/Allergan has similar numbers. Even for healthy patients, both were forced to admit that "most women experienced at least one complication over the three year period".

3) In general, breast cancer patients have complications with implants far more often than healthy people do. Many of the complications are about three times as likely for mastectomy reconstruction patients as for cosmetic augmentation patients. We regard this as socially the most acceptable and necessary time for implants to be used, but medically it is the most risky and unjustifiable time to use them. If you don't have a healthy body at the start when you're getting the implants, the odds of keeping healthy with them in place plummet.

4) Up to 9 percent of saline implants end up deflating within just three years, according to the Food and Drug Administration. The FDA also found that complications become more and more common for each year implants spend in the body.

5) Another FDA study found that even among women who had not complained of any perceived trouble with their implants, MRI scans showed two thirds of them have ruptured implants on at least one side. The rate was actually higher in 10 to 15 year old implants than with 20 year old ones, because the older ones were made with thicker containers. In 21 percent of women in the study, significant volumes of silicone were found to have migrated elsewhere in the body. Doctors removing implants often claim that they ruptured at the time of removal. This study makes me suspect, as some patients long have, that many doctors are lying about this for some reason, perhaps to avoid liability.

6) Though rare, it is not unknown for complications to be so severe that the breast ends up getting amputated. The chest wall can be injured. Your lungs and heart can be affected. You can end up dead.

7) They sometimes find cultures of microorganisms growing inside saline implants when they're removed. This is worrisome given that the newest implants contain vegetable oil... it could spoil. Saline, at least, is not a nutritious meal for bacteria. Even the silicone gel ones sometimes get some kind of mildewy looking stuff growing inside them... and each new fluid they've tried has been friendlier to microorganisms than the last one was.

8) If you're a European patient who has the option of oil-filled implants (these implants have not been approved in the US), British doctor Rahim Karjoo warns that oils leaking into the body will absorb calcium, and the resulting soaplike material, if it enters the bloodstream, can create fat emboli which can kill you without warning. The British government recently withdrew its approval for oil-filled implants and they will no longer be sold there.

9) Surgery in fatty tissues runs a much higher risk of difficult and dangerous infections taking root than surgery in lean tissue does. Infections with implants present are harder to treat than otherwise. In some cases the implant has to be taken out before the infection can be controlled. This problem affects about one breast augmentation patient out of 80.

10) So they replaced silicone implants with saline ones, avoiding the possible immunological problems associated with silicone gel leakage... and then the National Institute of Medicine decided that silicone has been "exonerated" and doesn't cause many of the problems it was accused of causing... So what -- somehow just about as many people have problems with saline implants as had trouble with silicone ones. The container is still silicone rubber, after all, which differs from silicone gel mostly just in the length of its molecules' polymer chains. Eventually, small flakes of silicone rubber come loose, and sometimes the chains break down chemically, yielding fluid silicone compounds, elemental silicon, and silica dust. (The operation often leaves stray talcum powder in the body, too.) The early silicone implants made by Dow Corning (now banned) simply allowed the interior gel to soak right through the containing capsule -- a fact that the company covered up. The implant container can also release traces of heavy metals like platinum (used as a catalyst in creating the silicone polymers) or lead, and carcinogenic solvents like xylene and toluene. A German study (J. Friemann, M. Bauer, et al) of the scar tissue surrounding removed implants found the tissue was commonly impregnated with chemicals from the implant, and also showed evidence of chronic inflammation occurring there. Some doctors believe that "capsular contracture", the most common side effect of implants, is directly caused by such an inflammatory response, meaning that the fraction of patients experiencing an immune reaction to the implants is quite large in proportion to the total population of recipients.

11) And if the official line is that silicone is now exonerated, then why isn't it okay to inject silicone directly into the body without a container around it, like they used to back in 1960? No doctor would try that now... they could land in jail. Some doctors are of the opinion that no facility that accepts blood or organ donations should take any from women who have silicone in their bodies, whether it's in a container or not.

12) The "exoneration" of silicone and implants is based on a failure to link it to certain autoimmune diseases that some implant patients were diagnosed with: arthritis, lupus, sclerodoma, etc. Interestingly, the same symptoms (sore joints, weak muscles, fatigue, cognitive difficulties) keep leading to different diagnoses, none of which was provable in itself. The obvious conclusion is that the condition is a separate disease that somewhat resembles these others. One theory is that many of these symptoms might be caused by ethylene oxide, which was used to sterilize many implants after they were manufactured, possibly contaminating the material. Another is that the common cause is an allergic reaction to the presence of traces of platinum. The studies also found no link with breast cancer... but overall cancers were another matter. Two recent NIH studies of overall mortality of women with implants, one from the National Cancer Institute (Dr. Louise Brinton) and one from the FDA, found plenty of extra mortality relative to patients of other plastic surgeries. Causes included lung cancer, brain cancer, a few other cancers, other lung diseases, and an increased rate of suicide. Finally, the important point to note about the dozens or hundreds of studies that supposedly show that silicone implants are safe is that not one examined a period longer than the initial three years after implantation.

13) One of the fastest growing areas of medical practice is surgeons who specialize in repairing the errors and complications of boob jobs done by other doctors. "If a doctor tells you they don't have complications, they're either not operating or they're lying to you," says Dr. Jack A. Friedland of Scottsdale.

14) A lot of doctors doing boob jobs and other vanity surgery are half-assed quacks without proper qualifications. Most states allow anyone with a medical degree -- even dentists -- to take a weekend course and sell plastic surgery. They do it because it's easy money. Dr. Ervin Moss of New Jersey says, "You can't imagine how many specialist groups are lobbying against [laws requiring proper accreditation] as a threat to the bottom line."

15) Can you imagine your doctor brushing off life-threatening complications and telling you "You look great!" when you ought to be heading for the emergency room? It's been known to happen in the cosmetic surgery biz...

16) You want health insurance coverage for other breast-related illnesses? Goooooooood luck.

17) The first time I had a chance to feel a pair of tits with implants in them, they felt like two blocks of cement covered with a quarter inch of skin. I was told it was an unusually high quality job, too.

18) They claim that the cement tit problem has been solved, and modern operations don't produce that kind of extreme hardening any more. Well, they still end up hardening sometimes. One doctor who trumpets the improvements over past techniques and calls saline implants "absolutely safe" (George Beraka of New York -- he gives plastic surgery advice on women.com and elsewhere) still admits that 5 to 8 percent can end up "as firm as your thigh" due to scar tissue... and that he sees "a lot of bad results" from other doctors. I think he's understating the problem rate... Mentor found that 9 percent of augmentations had serious capsular contracture (which causes hardening, and sometimes pain), sometimes bad enough to require reoperation.

19) The more we see blown-up boobs, the more we learn to recognize them instead of being fooled. The more we learn to recognize them, the less attractive they are. The more people are exposed to these bug-eye bosoms, the more often they are going to start seeing them as unattractive instead of as appealing. I've been seeing them that way for years now.

20) If I am not making myself clear, let me spell it out right now: implants are ugly! Implants only look good on the level of first impressions. Expect people in your life to react with an initial charge followed by a gradual accumulation of disgust. Anyone who likes you over the long term will do so in spite of them, not because of them -- the same as they would if you had a glass eye.

21) Lots of men have written me in response to this page and said they agree that implants are gross... but after tens of thousands of hits here, only a handful of men ever wrote to tell me they disagree and think implants are attractive... and sometimes I can't even be sure because the mail they've written is so inarticulate. (The total number of such messages written in proper English, so far, is about three.) From other mail I get, it seems to be very commonly the case that when women want implants, it's the men in their lives who are trying to talk them out of it, often without success. Our stereotypes tell us to expect the opposite -- men are supposed to be thrilled by this kind of "improvement". If our assumptions are backwards on this, how realistic is the rest of our thinking about implants? How much of what you look forward to after you have your implants is not going to work out the way you expect, because it's based on that kind of assumption?

22) If you envy women with big jugs, talk to them... a lot of them wish they could have smaller ones. (By the way, I wouldn't get breast reduction surgery either unless you're desperate. The surgery is more serious and, in the short term, probably more risky than breast enhancement is -- there are cases where the nipple, after being unplugged and stuck in a new position, dies and rots away -- but at least the risk is over once it heals.)

23) If you think being made fun of for being flat is bad... well, some women tell me that the amount of ridicule they experienced got worse, not better, after getting implants. Remember the old proverb about the color of the grass on the other side of the fence.

24) Any man who has a higher opinion of your body after you get implants will probably also have a lower opinion of your mind. Or do you imagine he'll never know? Fat chance. If they're saline and not overfilled to the point where they become unrealistically firm, he'll notice the sloshing.

25) An awful lot of implant jobs come out crooked, uneven, or weird looking. An awful lot of women think it's worth that, just to have the size. Does that make any sense to you? It doesn't to me.

26) If you're embarrassed because your titties are itty bitty and you want to do something about it... don't forget that the less natural breast tissue you start out with, the less convincing an implant job will look. The only ones that look halfway decent are when what's added is less than what was already there.

27) Fashions in body shape change. A lot of people nowadays are going to feel real stupid in 20 years when they look at the tattoos they've got... and you can bet the same is going to be true of a lot of cosmetic surgery. It happened with nose jobs: now there are a lot of women with nostrils aimed forward like headlights, making them look like a new species of pig. They don't do nose jobs that way any more, because it looks awful. Yet thousands paid to have it done that way, because that was the style at the time. Says one Hollywood actress: "That whole big chest thing is so eighties."

28) Speaking of fashions... some people have pointed out that strange, uncomfortable, weird-looking, fetishistic, and dangerous women's fashions tend to have an upsurge after any period where there are improvements in women's rights. We are in such a period now. I think implants have become such a fashion. In America, we've gotten accustomed to implants that, to someone from outside our culture -- even from a place as similar as England or Australia -- look bizarre and hideous.

29) However fashions go, when you get old, you're gonna look really weird and implausible. They call it the "double bubble" look -- each breast shaped sort of like the letter B. (That term is also used for a complication in which the underside of the breast has a second fold, like a double chin.)

30) Then again maybe you won't, because your implants probably won't last until then. Those who know say that anyone who gets implants should not keep them more than ten or fifteen years without either removing them or replacing them with a fresh set. This is because the container, though it's rugged when new, loses its strength and eventually becomes fragile. That means more surgery, with more expense and more risk... but not as much risk as leaving the old ones in place until they break or their contents leak out. One reason the rate of implant surgery keeps rising is because at least half of them are repeats.

31) Whether you replace your implants or take them out, it's going to be quite a challenge to find any way, as an elderly woman, to have halfway natural looking breasts. If you have any plans to ever get old, bear in mind that by getting implants now you may be throwing away any chance of not looking deformed at that age.

32) You have to protect your implants. A simple fall that would ordinarily only give you a bruising can create a major medical crisis if an implant gives way. The longer it's been in you, the more easily it will rupture. Putting implants beneath the muscle -- something that is becoming popular because the shape comes out less obviously fake that way -- means that eventually just using your shoulder strongly will put you at risk (assuming that your shoulder still has its strength after the muscle has been distorted). The extra care you need to protect and maintain the implants makes you just a little bit crippled as long as you have them.

33) Any surgery on breasts can, and often does, damage nerves and reduce skin sensation. The amount of loss is unpredictable. The damage can't be reversed. Attempts to reduce this effect have a tradeoff: they increase the visibility of the surgical scar. Complete numbness of the nipple is not unknown. In a smaller number of cases, the side effect is the opposite: painful hypersensitivity to touch.

34) If you feel inadequate as a woman, the problem to address is in your head, not your chest. Self esteem first, cosmetics after! If you ignore that, you are doomed to disappointment. A lot of people who think a cosmetic change like this is going to fix their lives end up despondent and suicidal when they find they're still the same person with the same life. This is such a common problem that cosmetic surgeons have to pay a lot of attention to weeding out patients who might be suicide risks. Getting chest surgery to improve your self-esteem is like buying a girdle to improve your eyesight: you're addressing the wrong problem.

35) Breasts probably have a wider range of natural healthy variation than any other body part... and we seem to be trying to forget this. If we act as if only one subset of the range of variation is good -- as the entertainment and advertising industries are currently doing -- we condone and reinforce a mindset that says ordinary people are defective. We distort our sense of what is normal and end up treating healthy people (including ourselves) as if they were pitiable freaks. Every additional person who gets that surgery adds to the marginalization of those who don't.

36) Treating your own normal body as being defective is an act of self-hatred. (That doesn't mean you feel hatred for yourself... but one thing I've learned in life is that the way you feel about yourself is as much a result of such actions as a cause of them.) Acting on this in a public way and flaunting the results before everyone rubs this off on other people; it becomes not only self-hatred but an act that carries disrespect to other women. You're like Michael Jackson bleaching his skin and having his nose narrowed -- the message that sends to other African-Americans is hardly a positive one.

37) What do you think you're really accomplishing by getting implants? If you examine your goals, you may find they are not very rational or realistic. Unless you're a professional model or are dedicating your whole life to the goal of marrying an elderly millionaire, the implants are probably not going to bring you much closer to what you really want. What are you really after? You'd better take a hard look at that question before you act on the assumption that implants will get it for you.

38) If you want more male attention, implants may increase the quantity but only with a corresponding decrease in quality. You'll probably get your biggest gains in approval among guys who are most prone to objectifying you, and least prone to treating you as an equal. The guys who like implants the best are those who prefer pornography to live women, and probably find ordinary women a turn-off if they're not somehow artificialized by things like fake hair, shaving, ridiculous shoes, and so on. Implants can be very artificializing. And don't forget that for every woman who complains that she doesn't get the male attention she wants, there's another complaining that she wishes she didn't have the amount she does get.

39) If you want to like your body better, the way to do it is to start liking the body you've got better. If your mindset toward your body is negative, no change of appearance will ever eliminate that! If you think it will, you end up chasing an illusion. When you are in the habit of always finding fault with your body, you will never run out of faults to find... indeed, you'll only find more and more as you get older. It's a trap, and changing your body won't get you out of it -- the one thing that will is to change the fault-finding way of treating yourself. If I treated you that way, I'd be an intolerable asshole... so why treat yourself that way? If you keep hitting your forehead with a rock, that doesn't mean you need a better stronger forehead -- it means it's time to put down the rock.

40) If you want a spicier love life... oh jeez. the only way implants ever help people's love lives is as a temporary crutch to get over inhibitions caused by body shame. This effect wears off. The only lasting way to remove such shame and inhibition is to tackle them directly -- for instance, to just start unconditionally refusing to view yourself as something to be ashamed of, and then working with whatever obstacles come up in trying to stick to that. It's slow to change but nothing can stop you if you stick to that decision. (And incidentally, it just might revolutionize your whole life.)

41) There are studies that use psychological tests to measure self-esteem changes after getting breast implants. Some found a slight improvement after three years, other tests found no change at all. The tests that found a slight improvement did not compare the sample group with a control group of people who didn't get surgery, to check against how much people tend to gain in self-esteem just by living. (Usually it's young people who have the most trouble with self-esteem.)

42) The worst time to get implants is when you're young. You already have a body that, in twenty years, you will wish you could have back. And yet when you're older you may be far more immune to the wishful thinking that tells you that a body part bought from a store shelf can improve your life. You'll be a lot less easily embarrassed about yourself, too. Imagine yourself twenty or forty years older and full of wisdom about life. What do you think that wiser future self would tell you to do? For that matter, imagine if you could ask God for an opinion. What do you think God would suggest as the wisest and truest course for your life? If the answer you get is different from what you think you want, this shows that something inside you actually knows better. Ignore that deeper wisdom at your peril.

43) Big knockers, whether natural or artificial, can be a hindrance in many physical activities. Making them bigger by choice is like hobbling yourself with a too-small pair of shoes because you're embarrassed by big feet. Proper support of fake boobs for physical activity is a more difficult problem than support of natural ones is. They're less tolerant and less adaptable. They get in the way a lot more than natural ones do because they're more rigid. There is no such thing as an implant with the resiliency of a real breast, no matter what some people claim.

44) Maybe you shouldn't believe those lists in tabloids of surgeries that various celebrities have had. "Only a tiny percentage have the work done [the tabloids] say", says Dr. Harold Lancer, a Beverly Hills dermatologist with major movie stars for customers. (Of course, he could be covering up for them...) As far as I have been able to learn from the sources available, most of the cosmetic surgery used by the stars is done on faces.

45) On the other hand, Hollywood certainly has no shortage of implants among non-celebrity starlets. Watch a bunch of late night cable TV swill and you'll learn to spot implants at a glance. If you sit through enough T&A exploitation movies to really get a good clear idea of how implants usually end up looking, I doubt very much that you will want to look that way yourself. I would recommend that anyone who thinks they want implants should try this before making a final decision. Anyone who can watch something like, say, Caged Heat 3000 and still want to look that way is weirder than I like to imagine.

46) Boob jobs cost a lot of money. If you're not rich, giving yourself implants means depriving yourself of something else quite substantial, which might do you more good.

47) Boob jobs are like stage makeup: they look good at a distance. They look better on you from 50 feet than from 10 feet, better from 10 feet than from one foot, better in a photograph or video than in real life, and better with more clothing than they do with less. They're at their worst when the distance is most intimate.

48) A lot of women inflict malnutrition on themselves because they think something's wrong or shameful about how much they weigh. Other women undergo mutilation because they think something's wrong or shameful about the shape of their breasts, or other body parts. In the former case, there's clearly something very flawed about the thought pattern that says "If I punish my body enough, I will be happy." Is the latter case really very different?

If my 48 reasons aren't enough, here is a page with even more reasons sent in to me by readers of this page.

From time to time I get mail about this page saying things like, "But you don't understand how hard it is to live with a flat chest." Here is an open letter to any woman who feels similarly.

(There used to be a discussion forum, but nonconstructive hostile bickering pushed out the more positive uses, so I took it down. People aren't likely to share support on sensitive issues in that kind of environment.)

A note to those who want to write angry letters saying "What gives you the right to decide what someone else can do with her body?" I have not told anyone what they can or can't do, I have only discussed the consequences of different choices. Okay? Have we got that clear? The same goes for those who want to accuse me of somehow bashing women, or implying that anyone who considers implants must be insecure and inadequate. I said only that if you feel that way, cosmetic surgery isn't the solution.

For hideous medical photos with all the gruesome details of how badly implants can go wrong, see this site. And here is a Yahoo group for people who've had trouble with saline implants to share support.

Some readers ask why I don't complain about other dangerous cosmetic procedures. Here is a brief list of some other risky things people do to be attractive, and reasons to avoid them:

Liposuction: the #1 cause of dead bodies in plastic surgeons' offices. It's just too easy to create a drastic hemorrhage during the procedure. A few years ago, the statistic was that something like one patient in 5000 was dying of it. Also, recovery time is very prolonged.

Human Growth Hormone: evidence is increasing that far from "turning back the clock", HGH usage actually shortens your lifespan. And overuse can cause disfiguring bone growth.

Steroids: if you're male, steroids can help you build bigger muscles, but they can also give you troubles with aggressive behavior and they can also actually shrink your genitals. If you're female, the muscle growth difference is much more dramatic, but so are the side effects... including, particularly, breast shrinkage. And do you really want to have to shave every morning?

Speaking of genital size, vacuum penis enlargers do work, but I'm told they leave your penis with a weird unrealistic rubbery texture, and the more you use them, the softer your erections get.

Facelifts have sometimes created side effects of extreme sensitivity to light, noise, and pressure. On the other hand, facelifts have sometimes been known to unexpectedly cure chronic migraine headaches. In either case, over-facelifted people end up looking more like lizards than like mammals.

Hair transplants for baldness often produce very disappointing results, and sometimes (especially if repeated) can end up killing off more of your hair follicles than you were losing already. Scars can sometimes be quite visible, and a poorly done job can make your scalp all bumpy. (To see how I personally was coping with male pattern baldness at the time of writing this, take a look at my haircut.)

People will do incredibly nasty stuff to their skin to attack wrinkles: grinding off the skin surface with abrasives, burning it off with acid, etc. One of the weirdest approaches is called Botox. That's short for botulism toxin, one of the deadliest chemical poisons in nature. Minute amounts can paralyze small facial muscles, which has a smoothing effect. You actually want a paralyzed face?

I just learned of an appalling cosmetic medical abuse, which has apparently been going on for decades with no particular monitoring of the long term effects: perscribing massive doses of estrogen to girls in their early teens who are worried about growing too tall. This simulates the effects on the body of getting pregnant at that age, one outcome of which is to stunt your growth so you never reach full adult size. Now it's coming out that women who received this treatment as girls are prone to infertility, and even without that problem, very few who've had this treatment are glad they did.

In addition, here are a couple more vanity medical procedures that are not cosmetic, but have similar roles in our health system as easy money for doctors who don't care about healing the sick:

In-vitro fertilization. Scientists are starting to realize that if you mash together an egg and a sperm that won't go together by themselves, that might be telling you that there's something wrong with the combination. Nature has a lot of checks and balances to make sure that only the right sperm succeed in fertilization; we end-run these checks at our peril. At least one type of IVF is now coming under tightened regulation because of the extra birth defects coming out of it.

sperm succeed in fertilization; we end-run these checks at our peril. At least one type of IVF is now coming under tightened regulation because of the extra birth defects coming out of it. Another thing to be cautious about is LASIK vision correction. Even with a perfect outcome, the vision correction is inferior to what was attainable through the old RK procedure that nobody does any more, in that it can't make your night vision sharp. And too many outcomes are less than perfect -- it comes out bad in something like 3 to 5 percent of cases. And when that happens, there is often no possible repair of the damage: your vision is hosed forever. Doctors like it because, unlike RK, it's quick and automated. But something as simple as an asymmetrical pupil can fool the machine into mangling your eye.

of the damage: your vision is hosed forever. Doctors like it because, unlike RK, it's quick and automated. But something as simple as an asymmetrical pupil can fool the machine into mangling your eye. And I might mention that ever since Viagra came out, the pharmaceutical companies are putting bigger and bigger portions of their research into "lifestyle" medications instead of health medications. Do they give a crap how many thousands of poor people constantly die of tuberculosis or dysentery? Not very much. They care about how many thousands of dollars people will pay per year for the perfect weight loss pill or hair restorer cream. The result is a coming wave of what you might call vanity pharmaceuticals... and like Viagra, over-reliance on them is going to be just as good for you as abusing any feel-good street drug is. The pharma companies have chosen to become pushers.

Do breast enlarging pills and creams work? Apparently the answer is: not really, but maybe a little. Evidently they can produce a sort of temporary swelling, but they do not produce actual growth. They do this by messing with your hormones, which can have side effects; some of them contain ingredients that are considered unsafe before menopause. A lot of disreputable ads for them have been appearing lately, and at least some have been caught in lies such as citing nonexistent studies of effectiveness.

Do vacuum breast enlargers work? It appears that they do, sort of. (In fact, I recently learned that vacuum techniques have been promoted for breast enlargement as long ago as 1870. Vacuum penis enlargers go back even further.) Whether they have negative side effects like those of vacuum penis enlargers I don't know yet. I did hear from one lady who was in a clinical trial for an expensive new vacuum breast enlarging system called Brava, and she had to quit because of how much it hurt her boobs (bruising, rash). The claims on Brava's site are apparently less than honest in revealing the results of that clinical trial.

Now that the Brava has been sold to the public for a while, a realistic picture is starting to emerge, and results are mixed. Often the amount of growth is minimal; in some cases it's substantial. Rashes are common, welts and blisters are not too rare, and weird infections sometimes happen. Antibacterial soap may reduce that problem. A few Brava users find that the suction makes them start lactating. Those interested in the Brava should probably check some of the criticism by frustrated users, such as this one: Brav-argh. (And speaking of them, guess what's happened: the word "brav-argh" has now been co-opted as a fake search keyword by sites selling fake breast enlarging pills and creams.)

Number of women (before I stopped counting) who have told me that they decided against getting a boob job at least partly because of this page: 77

(This is now years out of date -- this page hasn't been updated in a long long time.)

We are allowing too much of our culture and daily experience to be overwhelmed by advertising, marketing, and cosmetics. As Susan Faludi has pointed out, nowadays even the definition of masculinity, let alone femininity, has become mostly cosmetic. Let's start with our own lives as the place to resist this trend.