The XX Factor

Who’s Fueling the American Fake Boob Trend? In Part, Breast Cancer Survivors.

Not just for Playmates anymore

Photo by Miguel Medina/AFP/Getty Images

Amanda M., I was also fascinated to see that breast augmentations have tripled in the United States in the past 15 years. According to a survey by the American Society for Aesthetic Plastic Surgery, American surgeons performed 101,176 breast augmentations in 1997, and 316,848 in 2011. But the trend doesn’t just speak to our country’s love affair with “big, fake boobs.” There’s a silver lining to why American women are rocking more breast implants these days: The option is now a lot more accessible for breast cancer survivors.

In 1998, the Women’s Health and Cancer Rights Act began requiring health insurance plans that cover mastectomies to also foot the bill for reconstructive surgeries, many of which involve implanting the same saline and silicone prostheses favored by The Girls Next Door. From 1998 to 2007, post-mastectomy reconstructions doubled.

How do these reconstruction rates compare to those of purely aesthetic breast implant procedures? It’s hard to know. Those annual aesthetic surgery reports rely on voluntary surveys administered to plastic surgeons around the world, and many of those doctors are performing reconstructive procedures alongside purely elective ones. The Surveillance, Epidemiology and End Results (SEER) database, which tracks American mastectomy patients, does keep tabs on some reconstruction procedures. But it follows just a fraction of all the women who receive mastectomies in the United States every year, and only records reconstructions completed within four months of the breast removal. Some breast cancer survivors need to wait to complete radiation and chemotherapy treatments before reconstruction is an option. Down the line, the American Cancer Society estimates that as many as half of women who receive implants as a part of their reconstruction will need to undergo an additional surgery to replace them within the decade. And many women who have a breast reconstructed after a single mastectomy will opt to perform an aesthetic lift, reduction, or augmentation on the opposite breast as well. While rates of aesthetic breast augmentations appear to be soaring, it’s likely that reconstruction rates are underreported.

What is clear is that reconstructive patients now make up a significant portion of women with “fake breasts” in the United States. The American Society of Plastic Surgeons, which does record breast surgeries coded as reconstructive, tallied up 96,277 breast reconstructions in 2011. I have a call out to ASAPS for some better clarity on the breakdown of its numbers, and will update if the organization responds. But even if we assume that ASAPS’s big, bad 316,848 boob jobs don’t include any reconstructive patients, that still means that about a quarter of women who receive new breasts every year are doing so in the course of their medical recovery.

Reconstruction isn’t for everyone—most women who undergo a mastectomy still opt out. And in the case of underinsured, low-income, and rural breast cancer patients, it remains an inaccessible option. But studies have indicated that the procedure’s rise has helped many women improve feelings of self-worth, body image, and “social and occupational functioning” that have been compromised by a mastectomy. And according to Dr. Leigh Neumayer, a professor of surgery at the University of Utah, many breast cancer patients take cues on reconstruction from survivors in their communities. As breast implants become normalized for cancer survivors, more women will have access to—and be thankful for—the choice. It’s just another reason why we should reconsider the stigma against all-American fake boobs. In this case, I, for one, welcome our silicone overlords.