Making Sense of Bioethics: Column 034: Plastic Perfection? The Ethics of Breast Implants
In the last 10 years, the number of women undergoing breast augmentations has increased dramatically. Many seem convinced that breast implants are an easy way to shore up their self-image. As one woman put it, “I got implants so that I could gain back my confidence and feel good about myself.” The growing popularity of this kind of plastic surgery, however, raises a constellation of health concerns, ethical questions, and personal/spiritual issues that may need to be confronted whenever the temptation to pursue elective breast augmentation arises.
As a general rule, there should be a compelling therapeutic reason whenever we elect to undergo breast augmentation, because surgery and anesthesia always involve risks. Breast implant surgery is not considered “therapeutic” in the traditional sense, except for women who have undergone a mastectomy, or otherwise suffered significant breast damage, in which case the procedure may indeed represent a reconstructive or restorative therapy.
Implants, of course, are serious business - real surgery with real side effects and strange things that can go wrong. Choosing to increase the size of otherwise healthy breasts raises health-related concerns. Implants can rupture or develop leaks. They may need to be replaced periodically. The decision to get implants, particularly at an early age, is an almost certain guarantee of more surgeries later on.
Implants may increase diagnostic difficulties associated with doing mammograms. Some women report that implants make self-examinations harder. Implants and implant surgery can also affect the purpose and proper functioning of the breast, by causing lactation insufficiency and other complications associated with breast-feeding.
Women who feel a strong need to augment their breasts may also be struggling with deeper personal and spiritual issues regarding their own self-image. All of us are keenly aware of the way that people react to us when they first meet us, and whenever they respond negatively to our appearance, it can damage our self-esteem. In our society, attractive people often end up receiving preferential treatment, and this seems especially true for women. The result is a peculiar kind of pressure on women: on the one hand, they are valued for their beauty and feel compelled to conform to the societal ideal. On the other hand, elective breast augmentation seems to go too far in an effort to meet that ideal. It seems to cross an ethical line by saying that women should alter their healthy bodies in very radical ways in order to conform to what is portrayed on television or in glossy women's magazines. The escalating use of pornography among men may also be contributing to this pressure to conform to the digitally enhanced and hyper-sexualized images of the computer screen. In the face of so many disordered and unreasonable pressures, undergoing an augmentation may at times represent a form of unethical self-mutilation in the name of some other perceived good.
Pursuing this so-called “plastic perfection” can lead to a shallowness and an unhealthy self-focus. I recall the story of a young man who got seriously into body-building and weight lifting. He worked many long months to bulk up his physique. Soon he realized that his focus had become so intense that it had managed to turn into a completely self-centered behavior, and when he would pass by a mirror he couldn't help flexing his muscles to see whether they had gotten any larger since the last time he checked. A similar self-centeredness and vanity can arise in the woman who focuses too much on her figure or her profile.
There can be something embarrassing and slightly scandalous in the realization that women really want to do these elective procedures. The psychological flaw here, one might argue, can be even uglier than any perceived chest size "flaw." A negative self-image can be very tough to overcome, and implants can tempt us with a kind of false answer.
The temptation to reduce feminine beauty to a kind of plastic and exterior measure is surely a failure to realize how a woman's physical beauty is meant to be but a gentle hint, a pointer towards an abiding beauty within. I think it was Albert Einstein who once remarked that beyond what we perceive with our eyes, “there is something that our mind cannot grasp and whose beauty and sublimity reaches us only indirectly.” A woman’s outside image will have some relationship to the woman she is and wants to be, but that exterior image is necessarily partial and incomplete, and should spur every woman to pursue that deeper feminine beauty and virtue that is properly found within.
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