A brief history of boob jobs

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Just the other week, the US Food and Drug Administration (FDA) requested a voluntary recall of certain Allergan Biocell textured breast implants and tissue expanders, which have been linked to a rare form of lymphoma known as breast implant associated anaplastic large cell lymphoma (BIA-ALCL).  These are the same textured implants that were pulled from the European market in December of last year. Fifty-seven years after the inaugural enlargement surgery, breast implants continue to make headline news. 

The term ‘boob job’ usually refers to breast augmentation, also known as augmentation mammaplasty, the surgical practice of using implants or less commonly, fat transfer, to increase breast size. Boob jobs are the most popular cosmetic surgery in both the US and the UK, but the procedure as we know it today is still relatively new. In 1962, Timmie Jean Lindsey of Houston, Texas was the first patient to undergo a modern breast augmentation. Surgeons Thomas Cronin and Frank Gerow performed the groundbreaking surgery using silicone implants on the then 29-year-old mother of six. 

The procedure, and indeed its popularity, have come a long way since 1962. The path to the modern boob job was one of serious trial and error—not to mention a grisly affair for the patients along the way. In 1895, German surgeon Vincent Czerny performed the first breast reconstruction surgery by using a lipoma (fatty tissue growth) from a patient’s lower body to fill the hole left by a tumour. Around the turn of the nineteenth century, practitioners began injecting paraffin directly into women’s breasts. Results were immediate and side effects only started to show themselves anywhere from five to ten years down the line. Complications were painful and disfiguring—often requiring amputation—if not downright fatal. By the 1920s, the paraffin boob job had gone out of style, only to be replaced by the industrial silicone boob job during World War II. The trend began in Japan, where sex workers injected industrial silicone directly into their breasts—supposedly an attempt to trade better with U.S. soldiers. Still, options for those looking to permanently enhance their cup size were limited and risky. The 1950s saw breast enlargement through surgical implantation of various materials, including synthetic sponges, which hardened and lost their shape over time. 

Today, patients can choose from a range of smooth or textured implants filled with either saline or silicone gel. Silicone implants tend to have a more natural feel, but they were taken off the US market (though still used in reconstructive patients and clinical studies) in 1992 amid growing concerns about the safety of silicone. Saline-filled implants contain a sterile saltwater solution, which the body easily absorbs in the event of a leak or rupture. In the US, saline was the only option until the silicone ban was lifted in 2006 after the FDA received what it deemed sufficient safety data from implant manufacturers. The FDA has approved the use of saline implants for breast augmentation in patients age 18 and older, and silicone implants for augmentation in patients age 22 and older.

However, as with all medical devices, implants still carry risks. Back in 2010, it was revealed that French manufacturer Poly Implant Prothese (PIP) had used industrial, rather than medical-grade silicone to produce its implants. The resulting devices posed greater risk of leak or rupture. The company’s founder went to jail.

More recently, news coverage of BIA-ALCL has brought attention to the possibility of other implant-related health complications, including something called Breast Implant Illness (BII). BII refers to a collection of seemingly unrelated, systemic symptoms such as chronic fatigue, mental fog, hair loss, skin rashes, anxiety, and even the development of certain autoimmune diseases, which some patients believe are directly related to their breast implants. BII isn’t an official medical diagnosis, and there’s no test to determine if you have it. Because of this, women have had trouble being taken seriously by the medical community, until now. A movement of BII advocacy groups are gaining traction on social media. These communities, along with the evolving discourse surrounding BIA-ALCL, have empowered women to speak up about their experiences with BII. While there isn’t a “cure,” per se, many BII sufferers do report feeling better after having their implants removed. There are several new and ongoing studies into Breast Implant Illness, but the field is still young. It’s also important to point out that many people with implants don’t experience any complications. 

Reasons for going under the knife vary immensely, but it should be noted that the American Society of Plastic Surgeons (ASPS) classifies post-mastectomy breast reconstruction and transfeminine top surgery as reconstructive procedures, whereas breast augmentation is considered a cosmetic procedure. 

Gina (who asked that we not use her real name), first went in for augmentation in 1997, just after she finished breastfeeding her second child. For most of her life, Gina remembers really liking her breasts. It wasn’t until breastfeeding her first child, that Gina began to consider augmentation. “That’s when they just tanked. I was left with basically just a nipple and these really saggy little breasts.” 

Gina had her original saline implants replaced with silicone implants last year. In the twenty-one years between her first and second augmentations, Gina had been diagnosed with breast cancer and had radiation in one of her breasts. Considering the time frame, as well as the radiation—which Gina says seemed to make her breast appear “droopier”—her implants held up surprisingly well. But over time, her breasts fell while her implants stayed the same, sitting too high up on her chest. 

Breast implants aren’t guaranteed to last forever. Whether or not they’ll need to be replaced depends on the patient. “About 45% of women—in the course of the lifetime of an implant—may need another operation,” says American Society of Plastic Surgeons (ASPS) President, Alan Matarasso, M.D., F.A.C.S. Factors include: patient age, initial type of operation, and the changes they undergo, among others. Matarasso advises patients seeking implants to have an ASPS member input their data into the National Breast Implant Registry, a medical database that tracks implants for safety and quality improvement. 

"Massive fake boobs have fallen out of trend"

Where cost is concerned, the reconstructive-versus-cosmetic surgery paradigm means that within the treacherous American healthcare landscape (as well as the NHS), boob jobs that don’t fall under post-mastectomy or gender confirmation are most likely an out-of-pocket expense. With a US average cost of $3,824, and UK prices ranging from £3,500-£7,000, the probability of a second surgery is well worth taking into account when considering the cost of an initial boob job. Also worth pointing out: implants can make mammograms more difficult, so it’s always best to inform your technician beforehand. 

A smooth silicone implant is usually the model of choice for Matarasso’s patients, and—fourteen-year silicone moratorium aside—that’s remained constant throughout his practice. The size and style requests of his patients have also remained consistent throughout the years. The patients Matarasso sees at his Manhattan practice, “often don’t want an overly-large change. They want to look like a better version of themselves. If they’ve had children, they lose volume, so they want more volume back.” 

But the same can’t be said on a larger scale. Societal ideals and cultural norms continually evolve. Think of the 1920s flapper look, which pioneered loose-fitting fashion and favoured a flat-chested, androgynous bodytype. And then the 1950s, where Marilyn Monroe’s big-busted pinup shape gave way to what would become the Playboy ideal. Trends oscillate, even when it comes to breasts. In the nineties, Kate Moss’s waifish frame was countered by the busty buxom women of Baywatch, who at one point had a weekly audience of 1.1 billion viewers. The arrival of Pamela Anderson and her giant melon implants undoubtedly had a profound effect on pop culture—so much so, that costar Nicole Eggert reportedly felt pressured into getting a boob job of her own. Meanwhile, porn icon Jenna Jameson was beginning her adult film career with a pair of equally iconic implanted 34Ds. A few years later, glamour model Katie Price had her first in a series of breast augmentations that would take her up as high as a 32GG. 

But recently massive fake boobs have fallen out of trend. They’ve become associated with dated porn and its synthetic, hairless, french-manicured, liplined artifice. Not only that, but many of the women who helped champion the look, including Pamela Anderson and Jenna Jameson, have since had their enormous implants removed (both citing physical discomfort and feeling unhappy with the way they looked). 

Among celebrities, implant removal surgery—a sort of reverse boob job—has become a trend of its own. Stevie Nicks, suspecting her implants were to blame for her chronic lethargy, had them removed in 1994. Victoria Beckham spent years denying rumors that she’d had a boob job, only to finally open up about it after apparently having her implants removed. Crystal Hefner (widow of the late Playboy mogul, Hugh) cited Breast Implant Illness as the motivation for her implant removal in 2016. Yolanda Hadid (mother of Gigi and Bella) had her implants removed on an episode of The Real Housewives of Beverly Hills. Hadid also stopped using botox, fillers, and hair extensions—all of which she referred to as the “bullshit” that society had conditioned her to think she needed in an instagram post earlier this year. 

"Low self-esteem is often the force that drives people to the operating table of their own volition"

Disproportionately large augmented breasts can create the type of body strain that leads naturally busty patients to seek out reduction surgery. In a 2017 post on the ASPS blog, Kevin Tehrani, M.D. discusses the small implant trend. In addition to the preference for a more natural look, Tehrani highlights the desire from patients who want to continue high-impact exercise without being weighed down by heavy, cumbersome implants. After all, breast size does affect how women exercise. 

While Matarasso hasn’t witnessed a significant change in implant size requests over time, he does point out that today, trends vary based on climate and geography. “Statistically, we do know that in warmer climates—whether it’s Texas, South Florida, Southern California—there is a tendency for bigger implants to be used.” Implants range from around 100 cubic centimetres, or cc’s, up to about 600. Matarasso stresses that he “very rarely puts in anything above 400 or 350,” though it’s “very much a choice of the patient.” Debra Johnson, M.D., F.A.C.S. explained the regional divide best when speaking to Allure in 2018. “In the West,” she said, “because the weather is better and people are a little more exposed, a lot of women are more aware of what their breasts look like in public.” 

Breast augmentation continues to be the most popular cosmetic surgical procedure in the world, per the International Society of Aesthetic Plastic Surgery’s most recent study. Globally, the US performs the most cosmetic surgical procedures, with Brazil in a close second place. With such staggering international statistics, you might say the boob job is thriving. But as with the outmoded enlargement technologies that came before, some patients are now experiencing implant-related illness years after their augmentations.

For some, boob jobs may seem like superfluous incisions. But like any cosmetic surgery, motivations can be deep-seated and effects, life-changing. Low self-esteem is often the force that drives people to the operating table of their own volition. This was the case for Gina, who stresses that she’s not someone who’s easily drawn to plastic surgery or being put out in any way. “It takes a lot for me to go under the knife,” she says. But her breasts had done a number on her self-esteem.  For all the necessary maintenance and possible side effects, would Gina—now in her early fifties—choose to do it all again? “One hundred per cent,” she says. “I felt like a new person.” 

The way Matarasso sees it, “there’s probably some intrinsic desire, on many peoples’ part to want a better shape or more fullness to their breasts.” That’s probably not going to go away. But today, with the help of a boob job, that desire can be met. And that’s no small feat. Breast implants can create a more natural look and feel than ever before. But as breast augmentation technology progresses, and new science is brought to the market, new side effects (like those reported by self-identified BII sufferers) and potential risk (of BIA-ALCL, for example) follow suit. What’s next for boob jobs? Trying to maintain—and improve the natural look and feel, while ensuring the surgery is as safe for the patient as possible.