The XX Factor: What women really think.

Solutions for Flat-Chested Beauty Queens

LEWIS: ... it's a personal choice. Well, I think that it's about how a woman feels about herself. In terms of, for me, it's not a personal choice that I would recommend. But at the same time, I know so many women that have done the procedure and feel better about themselves and the way they present themselves.

And I think that's the question is, whether or not, when you're looking at that procedure as an option, am I going to feel better about myself? It's not about one night. It isn't about one night of competition. And doing a procedure like that for one night of competition would be foolish...

RODRIGUEZ: ... if you have a flat chest, what are you supposed to do?

LEWIS: You use chicken cutlets. You use tape. You use anything that you can to enhance the line. There's lots of tricks of the trade. It's just a matter of whether or not you want to go to that next level.

RODRIGUEZ: I wonder if you should change the rules and maybe not judge it so much on proportion.

She Wants a Famous Face

Who's Got It Worse?

Reading "Plastic Surgery Confidential" and "Growth Industry," I was struck by the similarities between the two. In the first, 27-year-old, 120-pound Melanie Berliet visits a slew of plastic surgeons who inform her that she's in dire need of $30,000 worth of plastic surgery. In the second, Kent Sepkowitz investigates male "enhancement" procedures that promise to turn men's penises into frankenfurters. There are plenty of women-run sites devoted to lamenting the multitude of ways pop culture turns female self-love into self-loathing, but far less attention is paid to how pop culture makes men neurotic about their masculinity.

In one surgeon's office, Berliet meets the Axis Three, a high-tech digital visualization program that uses fancy effects to show prospective surgical patients what their boobs might look like after they've been implanted. Meanwhile, at the University of Belgrade, men can have their penis disassembled and lengthened with the help of a transplanted rib. I'm actually all too familiar with the male "growth industry," having done more than one story on the subject, from penis weight-lifting to penile enlargement surgery. (Regarding the latter, suffice to say, it wasn't pretty.) 

In "Posthumans Go Hollywood! (Maybe)," Charlie Jane Anders asserts the cyborgization of the population is about escapism. But when the cyborg is you, is the escape from yourself or from the human population? While there's something pleasurable about imagining a world in which you can become whomever you want to be, the haunting backdrop is that of someone who inhabits a double-consciousness, stuck between who they appear to be and who they really are, the gap between unbridged.

What Price Beauty?

The End of Beauty?

Now the Times suggests the recession may spell the end of beauty as we know it, particularly the 21st-century plastic kind. Apparently, the economic downturn has resulted in fewer women getting elective boob jobs and sushi-party Botox injections. God forbid that on top of a skyrocketing unemployment rate, America will be further reduced to suffer the return of sagging breasts and smile lines. Will this recession stop at nothing? As a marketing adviser to plastic surgeons queries rhetorically, "If you are going for buttock implants, do you really need that?” For some, the answer may increasingly be: "No. I do not need those buttock implants." While I'm saddened to think that women who dream of looking like the bolted-on-breasted and frozen-faced cast members of The Real Housewives of Orange County may have their dreams deferred, perhaps more women will turn to alternative beauty therapies, instead—yoga to combat gravity's pull, cosmetic acupuncture treatments that have been used since the Sung Dynasty—and grow old gracefully for less.

So 25 Grand Gets You Nine Months in an All-American Womb These Days and That's OK?

I'm with you, Susannah, on Alex Kuczynski and her (college-educated!) rent-a-womb. There are worse villains to vilify at a time like this, Internet haters! Right? Why does it continue to be so profitable for self-respecting media institutions to incite reader rage over harmless rich socialites who are not asking for as much as a penny of TARP funds? (I mean, imagine if wealthy men got pregnant! Imagine what impoverished, uneducated communities they'd be outsourcing the job to. Oh wait, there's a thriving surrogate industry in India as it is.)  Which is to say, um, was there not something off-putting about the economics of it? In vitro, while certainly not covered by most health care plans, is covered by some—and in any case, it's certainly a tax-free expenditure of a hundred grand. And for a quarter of that, Kuczynski finds a whole woman—a college-educated woman!—willing to carry around Kuczynski's child in her own goddamn womb for nine months? Hey, and now she's written a story about it; she can write off that money, too! (Plus, she probably made about exactly $25,000 writing the piece anyway.)

God, so what does it mean? Well, on one hand, that's the free market at work, folks! And yet, on the other hand, Kuczynski—who wrote a book about cosmetic surgery and a regular Times column critiquing fancy retail "experiences"—has this way of positioning herself smack in the middle of industries that thrive off the most loathsome markets! Take in vitro and cosmetic surgery: Both draw in some of the nation's most talented doctors by freeing them from the migraine that is haggling with insurance companies, the same insurance companies that have helped make basic health care costs so expensive that regular college-educated ladies like Kuczynski's surrogate are willing to be implanted with alien zygotes and carry them around inside her for the better part of a year. (Oh yeah, and did I mention, quit drinking? While Kuczynski gets to … not quit drinking? ) It's just no faiiiirr, not to mention creepy, and while I'll gladly admit it's a bit of both to the anonymous cow whose teat to which I fully intend on outsourcing my milk production if and when I ever have kids, it's a little different when you're talking about people, right? And I guess I'd just feel better if it seemed like Kuczynski had thought about it this way. Because there are a lot of people in this country who are wealthy enough to spend 25 grand outsourcing their pregnancies, and there are hordes more who are desperate enough to rent out their wombs, but once upon a time we lived in a country where the former camp would have been more inclined to adopt from the latter half. At least, that's what I've always been told.

But a Boob Job IS an Investment

In his "Human Nature" blog, Slate's Will Saletan rejoices over the recession's toll on the cosmetic surgery business and expresses horror at the idea that some suckers (social parasites?) still refinance their homes to get cosmetic surgery during economic downturns. Then these vain people justify their ill-gotten boobs and rhinoplasties on the grounds that their plastic surgery was "an investment." Saletan cries foul: "When you can't pay the mortgage, we're supposed to bail you out? And your surgeon calls what you did an 'investment'?"

But isn't that a perfectly reasonable perspective? Sad but apparently true: We live in a society that rewards beauty and punishes ugliness, often using the medium of cold, hard cash. A 2005 Federal Reserve study, for instance, found that attractive people—in all occupations—earned 5 percent more per hour than the physically average, while the ugly earn 9 percent less an hour than everyone else. So say you find yourself, through sheer genetic bad luck, stuck in the low-earning "ugly" category—why shouldn't you decide that putting down $5,000 for a nose job or $2,500 for a "chin augmentation" is a smart long-term investment? If you can go from "ugly" to "average," you've potentially got a lifetime 9 percent income boost right there! Even if you're utterly devoid of vanity, some wisely chosen plastic surgery might be a sound economic decision.

I'll go further: Research suggests that the benefits of physical attractiveness start at birth. Nurses in maternity wards spend more time with the cute babies. And even parents, God help us all, apparently take better care of cute kids than of ugly ones—in a 2005 Canadian study, researchers found that parents with unattractive children often didn't even bother to buckle the little tykes' seat belts. Clearly, parents, if you want your ugly kid to get a fair shake in life, you need to get him or her to a cosmetic surgeon, pronto. And this, comrades, should be our new rallying cry: high-quality, government-subsidized day care; universal preschool; and free pediatric cosmetic surgery on demand!

Black Widow Freed Because Oops, No Murder

After we toast Danica, let's raise a glass (of milk, in case anyone's watching) to welcome Cynthia Sommer home from jail. As far as I can tell, Sommer spent 2½ years in lockup for getting breast implants and hanging out in bars. A San Diego jury heard a lot about what a tramp she supposedly was; Sommer even started dating again after her husband died! Then, they found her guilty of murdering him. According to the Los Angeles Times, prosecutors presented 34-year-old Sommer as an older woman (OK, it's Southern California, but still) who offed the 23-year-old Marine "to collect on his $250,000 life insurance policy and begin a new, fun-filled life'' in Florida, with new boobs and multiple boyfriends. Only—their bad—it turns out Sommer "was jailed 876 days for an arsenic-poisoning murder that prosecutors now say didn't occur.''

If only she'd been thinking ahead, she would have saved her pennies for a better attorney, because the first knucklehead she hired opened the door to a description of her "lifestyle'' that was so inflammatory the judge ruled she'd been deprived of a fair trial. He overturned her conviction for murder with special circumstances, which carries a mandatory life sentence. "The evidence about her breasts, drinking and sexual activity 'became like an overwhelming cloud that covered everything,' " her new defense attorney, Allen Bloom, told the Times. Yet Sommer was kept in jail—and separated from her four children, ages 8, 12, 13, and 16—while waiting for a retrial. Until last week, when new tests showed no evidence of arsenic in her husband's tissue samples. Bloom had already lined up experts who were going to testify that Todd Sommer's death could have been caused by the diet pills he'd been taking. And prosecutors were still interviewing the neighbors, hoping to find some additional dirt on Sommer. Maybe, while she's deciding whether to sue them, each prosecutor should be made to wear a big A pinned to his or her chest, like Hester Prynne in the Scarlet Letter. Except in that case, of course, the A stood for adulterer.

Slate After Hours

We Are All Under 40 Now

This excessive Botoxing and retouching has something to do with the collapse of the classes, or at least the shifting in what used to define the super-rich. "The 'luxury' experience has become thoroughly middle-class, even prole (two words: 'Gucci T-shirt')," Sandra Tsing Loh wrote a few years ago in the Atlantic, in a rare book review that did not reference her children's school. When I was in my 20s, my dermatologist was a product peddler, but in a sad pushcart kind of way, selling some kind of skin cream only he could provide (now Clinique sells it). I remember my mother once took me to Georgette Klinger, and I felt like I was in the Trump penthouse, and I in fact was so uncomfortable among the minks and lapdogs that I had to leave. Now Georgette Klinger is like the MacDonald's of spas; the super-rich go to these souped up urban spas where you can color your hair and get a face-lift in one session. I went with my post-mastectomy friend to the plastic surgeon once, and it was just how Melinda described—two doctors who looked identical, with absurd winter tans and actual golf ties. The place was gleaming, and they had their own chocolates! To me, the blending of boob job and cancer was very jarring. But they clearly considered both just facts of middle-class life. And they were just here to serve.

I'm sure there is no connection here, but since this is my latest obsession, I will try it out. If all classes have gotten bumped up a grade, does this explain why prostitutes are so middle-class now? In the escort service trial now unfolding in D.C., the latest call girl on the witness stand had a Ph.D. from the University of North Texas and held clinical and academic positions all over the world. She started working for the escort service when she was 56. Not a typo. She was caught serving a john at 63. Surely she must have had some work done.

Peddling Botox

Ah, yes, the unsolicited-Botox pitch. My experience wasn't nearly so harrowing or prolonged as Melinda's, but a couple of years ago I went to a dermatologist for a small, straightforward medical matter. It was hard not to notice the large photo on his examining room wall, showing him on vacation, trekking someplace exotic. At the end of our appointment, he took my file and looked at my birth date. "You're over 40," he pointed out, gratuitously. "Want to try some Botox?"

This was a mainstream medical doctor, seeing a patient for a medical matter, and here he was, peddling a pricey cosmetic sideline, doubtless as a way of paying his next sherpa. I declined his offer. He shrugged and assumed I was just offended. And in a way, I was; it's hard not to feel self-concious about your forehead when your doctor offers to correct some aspect of it. But mostly, I was shocked. I'd never had a doctor try to sell me something. It was no big deal to him. Some women resent the suggestion, he confided, but others don't. For that reason, he said, it's hard to know the best way to make the pitch. Next patient!

Cosmetic surgeons may be hurting in the current economy, but the pressures of managed care are also inspiring some some regular practioners to seek ways to augment their own income by performing—and proferring—cosmetic procedures. I was chatting about this recently with Kathryn Hinsch, founder of the Women's Bioethics Project, who has lots of concerns about physicians dabbling in lucrative cosmetic enhancements. The problems are manifold: It's cheesy, it commercializes medicine, and most of all, it corrupts doctor-patient trust. Hinsch pointed out in our conversation that general practitioners, family practitioners, and ob-gyns are all cashing in on the trend. And who are their primary targets? Well, women contribute by far the majority of cosmetic-procedure revenue.

And how are we paying for these procedures? On another topic, Melinda, just to tie up one loose end: That data set I mentioned last week, showing that one-third of all wives earn more than their husband? This may be a violation of the blogging ethos, but after your entry, I felt curious and made a call, to the Labor Department, to see if there were any caveats or backstory. It turns out that this statistic does not include families where the wife does not work. (The WSJ article was a little misleading that way.) But in families where the wife earns a paycheck, one third of the time she makes more than her husband. So she has even more $$$ with which to pay her GP for that liposuction!

Adventures in Plastic Surgery

(Disclaimer: As I explained to the judge who wanted to seat me on a med-mal jury, I am the sort of person who took one look at the plaintiff and barely managed not to yell, "You go, girl!'' Some practitioners may think they are God, but the distinction is not lost on me. I'll skip the tick-tock on how this became so clear, other than to reiterate that you should always, always—no matter how dismissive your doctor is—always biopsy a palpable lump. And if they later go to the opposite extreme and tell you you're dying? You might not be.)

My problem with the whole plastic surgery industry, in any case, is that it's focused on cosmetic enhancements to the detriment of patients in need of upgrades that are not quite so elective. I learned this a little over a year after my initial cancer diagnosis, when I again had to insist on having some new breast changes biopsied. Just before they wheeled me into surgery, my doctor half-jokingly complained to my husband that I was an awfully interactive patient: "Your wife has been reading again,'' he told him. They found only pre-cancer that time, but the safest course was still a mastectomy, and the reconstruction was going to be more complicated because I'd already had radiation. So now, I had to navigate a whole new corner of the medical world, where health concerns often seemed beside the point.

The first plastic surgeon my doctor referred me to was a highly regarded guy whose waiting room was filled with black marble and nurses who greeted me by name, in a whisper. I knew going in that he did mostly elective work, because even before my visit, I'd been sent literature describing the full array of available services. (A little eye job, perhaps, with my mastectomy?) Still, I was floored by how little he seemed to understand about my options, because implants under radiated skin are iffy. When I asked about the possibility of transplanting abdominal tissue, he said I wasn't a candidate for that procedure because I didn't have enough padding to spare. (And no, sadly, bulking up like Renee Zellweger for her role in Bridget Jones would not have worked; those fat cells are smart little buggers.) To underscore his point, he reached over and pinched my belly. "Do you want a breast that looks like this?'' Uh, not really, I said. But could what I wanted have been any more irrelevant? While mentally strangling him with the jaunty little golf tie he was wearing, I asked if he had ever operated on anyone in my situation. Surely he had, he said, but he couldn't really remember.

Next, I sought the advice of two top surgeons at a teaching hospital, who do the procedure I "wanted,''  a procedure known as the free flap. They said I could expect to lose maybe a third of my abdominal strength after they cut into my rectus muscle. "But you don't look like a rock climber to me,'' one of them added cheerfully, so I'd hardly notice. I wasn't so sure. Doesn't abdominal muscle support the back? And come in handy for exotic pursuits like hoisting groceries and children, or throwing a suitcase into the overhead bin? How about that new muscle-sparing version of the procedure I'd been reading about? Not an option, they said.

In frustration, I hauled out my well-worn copy of Dr. Susan Love's Breast Book, and found her reference to a doctor at UCLA who had done some pioneering work with the free flap. Though he had since retired, I located a young doctor who had trained with him and regularly performs a muscle-sparing version of the free flap, the deep interior epigastric perforator (DIEP) flap. And he had the answers I'd been looking for: "There's never any reason to take the abdominal muscle,'' he told me, "except to add volume to the breast.'' (How much is enough? Shouldn't that, if nothing else, be left up to us?) Finally, I asked him why the DIEP flap was not more widely available. "To be honest? Because it's hard to do and it takes all day. You could do two facelifts and be on the golf course'' in half the time, with twice the profit.

But vanity, too, can survive cancer. As I left his office after my first post-op follow-up, he dashed through the waiting room after me, and right there in front of Jesus and half of Santa Monica said he had some Botox left over at the end of the day, and would I like to try some at no extra cost? I love this guy, so not all doctors deserve the booby prize, so to speak. And you gotta, gotta, gotta love L.A.