Pandora's DNA: Tracing the Breast Cancer Genes Through History, Science, and One Family Tree
Page 20
New York neurologist J. Leonard Corning and Viennese doctor Robert Gersuny kicked things off in the late 1800s with paraffin. Paraffin comes in two varieties, a stiff, waxy moldable version and a form with the consistency of petroleum jelly. Heat them, and they turn into a liquid. Gersuny diluted his melted soft paraffin with olive oil and began injecting small amounts into his patients. The body would absorb the oil, his theory went, leaving particles of paraffin that connective tissue would form around, filling in hollows. The connective tissue, rather than the filling that the paraffin might provide, was his aim. By the turn of the century, doctors injected paraffin into faces to fill in wrinkles and correct saddle noses, into the scrotum to create a testicle in one case, and into breasts.
This turned out to be a terrible idea. Paraffin could migrate around the body and wreak havoc. One woman ended up with pus and bits of paraffin leaking out of the broken-down skin around her injection site. Her breasts turned bluish and required amputation. Paraffin also caused localized tumors and could get into the lymphatic system, as Karl-Heinrich Krohn noted in his 1930 case reports of women with breast injections. Years afterward, some of the women reported joint problems.
Paraffin wasn’t the only injectable disaster. Silicone, a new synthetic rubber, began to appear in medical devices in the 1940s and came in solid, gel, and liquid forms. Historians can’t seem to agree whether this next tale is apocryphal or not. As the story goes, silicone-based industrial coolant kept disappearing from the docks in Japanese cities during WWII and reappearing in the hands of cosmeticians, who injected it into their clientele—prostitutes who wanted bigger breasts to lure their American GI clients. In 1946 American doctor Harvey D. Kagan claimed he’d used industrial liquid silicone—Dow Corning 200 fluid—to inflate women’s breasts, but the technique didn’t gain more widespread purchase until the 1960s. According to a report by the National Academy of Sciences, sometimes the mixture included oils, concentrated vitamin D, talc, paraffins, and snake venom. (“Snake venom: because injectable silicone isn’t dangerous enough.”) To top it off, the report also includes a list of other horrific injectable enhancements, including beeswax, shellac, glazier’s putty, and epoxy resin. (“Epoxy resin: for when snake venom feels too safe.”)
By the mid-1960s, the silicone injection craze hit America both on and off the books. Famed San Francisco topless dancer Carol Doda underwent twenty weeks of expansion, receiving about a pint of loose silicone in each breast. By 1964, with reports of complications emerging, the manufacturer of the industrial lubricant used for injections—Dow Corning—voluntarily listed it as a drug with the US Food and Drug Administration (FDA). A year later, the agency classed the substance as such, and Dow Corning began manufacturing medical-grade product. Liquid silicone wasn’t available on the general market, but groups could apply to the FDA for permission to use it in controlled studies. However, these studies looked at low-volume silicone injections for correcting scars or smoothing out facial wrinkles, not high-volume breast injections.
Like so many beauty treatments over the years—lead powder to whiten and corrode the face, belladonna to give you sexy bedroom eyes and blind you—injectable silicone had serious side effects. At a minimum, it caused droopy bosoms later on. It also got into the lymphatic system and formed lumps in the breasts that made cancer detection difficult and could require amputation. If accidentally injected into the blood, it could cause rare but serious problems like gangrene, pneumonia, blindness, and death. A 1974 New York Times account of a divorcée who traveled to Tijuana for illicit injections vividly described the results. “Her breasts turned purplish, began ulcerating, and became horribly misshapened from the shifting and clotting of the silicone fluid.” The FDA had classified silicone injections as a new drug in 1966, ruling that it wouldn’t be approved for use pending further studies.
The siren call of insta-plumpness still lures patients, according to a 2012 Daily Beast article, now in the form of silicone butt injections. Originally popular among trans women, the seedy hotel-room procedure broadened its reach to women in the general population, bolstered by popular culture’s recent craze for leg meat and big booties. The complications still include lumpiness, migrating silicone, respiratory failure, blood clots, and death.
Injectable breast enhancement failed the most basic test of a successful cosmetic procedure: it killed and maimed people. Luckily for women, World War II spawned the creation of many alternatives. Just as the First World War precipitated a search for synthetic chemicals, including mustard gas that later ended up in use as chemotherapy, the Second World War spurred the development of many manmade elements that had potential as breast implants. An ideal breast implant would be chemically inert and would survive in the body unchanged for long periods of time, unlike human fat, which tended to absorb unpredictably, or liquid paraffin, which migrated around. And finally, the new plastics joined the medical milieu whose name they shared. Although surgeons tried the war-produced materials of nylon and Plexiglas in breast surgery, they ended up focusing on synthetic sponges made of polyester, silicone, or Teflon.
Surgeons tested the new sponge implants in animals first. A 1951 study put implants into dogs and found no adverse effects after eighteen months. A study published a year later found that foam implants caused cancer in mice, possibly due to some chemical property of the implant material. Still, by the late 1950s and early 1960s, a variety of sponge implants joined the market for breast enhancement. Women had problems with drainage and infection after surgery, which propelled advances in surgical procedures, as when plastic surgeon W. John Pangman tried squirting antibiotic solution into the implant pocket before installing the sponges. Unfortunately, sponge implants had a more intractable problem. The body invaded the porous surface of the sponges with fibrous tissue that contracted and shrank the implants—sometimes by as much as 75 percent—and hardened the breasts. Imagine the bloody difficulty of carving out those failed implants that the body had colonized. Despite some efforts to improve the devices—covering the sponges with plastic and different grades of foam—medicine abandoned the technology.
Breasts have a tactile pleasure—not just in how they feel to the woman who wears them but in how they feel to another’s touch—soft, pliable, and warm, so the next chapter in synthetic bosoms is fitting. Surgical resident Frank J. Gerow worked late at the lab one night in 1959. While he waited for a blood sample to fractionate, he killed time by playing with the hospital’s new toys—plastic blood bags that had recently replaced the old bottles. They felt kind of like breasts. He pitched the idea to his supervisor, noted plastic surgeon Thomas D. Cronin, who called Dow Corning to see whether they could manufacture a silicone bag to hold saline. By this time, silicone was used in other implantable medical devices—shunts for the heads of hydrocephalic children, for example—with no ill effect. Although there hadn’t been clinical trials on humans, doctors considered the material safe and inert. Cronin gave six dogs implants and followed two of them for eighteen months. By 1962 they had a prototype in hand and installed two implants into Timmie Jean Lindsey, whom doctors recruited for enhancement when she visited a charity hospital to have some ill-advised tattoos removed. Thirty years later, she still had the original implants.
Dow Corning launched the Silastic implant line in 1963, based on Gerow and Cronin’s design, at first for augmentation and then, two years later, for reconstruction. The Silastic model featured a rubber envelope filled with silicone gel and a mesh patch on one side intended to fix the implant into place without sutures. The first implant had issues—a seam edge that patients could sometimes feel through their skin and that could harden, and the mesh patch, which could cause scarring. Over time, Dow Corning refined the design: the envelopes became thinner, the gel looser and more like breast tissue; the seams disappeared, and the mesh patch shrank and then vanished altogether. Silicone implants had another advantage—they could be manufactured en masse and sterilized before shipping, unlike sponge implants, which doctors carved to fit the
patient and sterilized themselves. Alternatives filled with saline came on the market but had the unfortunate effect of deflating. Soon, implants of different shapes and providing varying levels of perkiness became available, presenting new choices to women who went under the knife.
Trouble still lurked on the horizon, though. In 1976, Congress passed the Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act, which granted the FDA the power to regulate medical devices. After more than a decade of meetings, the agency let manufacturers know they’d have to do studies to prove that implants met the “safe and effective” agency criteria.
At the same time, as the new operation became more common, complications emerged, most commonly in the form of capsular contracture. The body recognized silicone implants as foreign material and sheathed them in scar tissue. This capsule could shrink over time, causing pain, hardness, and a weird look, as one surgeon told me, like a baseball inside a tube sock. Concerns about “gel bleed” emerged—the new thinner implant envelopes could permit silicone to seep through, a problematic concern given the legacy of silicone injections. Even more alarming, case reports linking implants to autoimmune diseases were published in the 1980s. Everyone geared up for a messy fight in 1991. Plastic surgeons and manufacturers defended their livelihoods, while women who wanted boob lifts and cancer patients seeking reconstruction straddled both sides of the issue. Surgery reinvigorated some patients who felt pleased with their new décolletage, while others had suffered complications, from botched surgery to capsular contracture—and a few had rheumatoid arthritis they blamed on the silicone devices. Medical societies suspected fewer women would seek treatment for breast cancer if the FDA banned enhancement, an assumption that sounds pretty sexist, alleging that feminine vanity would prevent women from seeking life-saving treatment. On the other hand, I suppose I can’t judge since I might not have chosen mastectomy if I had known I would have had to live out life flat chested—the existence of reconstructive surgery made my decision easier. Was it a woman’s right to choose her own procedure, or to choose procedures that had been proven safe? Why hadn’t more studies been done?
Eventually, the government panel made an interim decision. Silicone implants would remain available to reconstruction patients participating in FDA-approved clinical trials. Augmentation patients would comprise a tiny portion of the studies and would have to stick with saline. No one liked the ruling because it distinguished between the needs of cancer patients and augmentation patients. If implant surgery fulfills a psychological need for bigger breasts, why should the desires of cancer patients trump those that nature made flat chested? Some cancer patients felt offended at the ruling’s suggestion that, as historian Elizabeth Haiken put it, “their illness made them expendable, appropriate for potentially dangerous experimentation.” If the problem was simply that no one had studied the long-term effects of implants, then the FDA’s decision implied that women weren’t smart enough to choose life over boobs unless the government stepped in and prevented feminine vanity from running amok. Interestingly, the panel’s decision left out testicle, calf, and pectoral implants.
Soon, the lawsuits exploded. In 1995 Dow Corning faced more than twenty thousand suits over its implants and more than four hundred thousand potential lawsuits worldwide. Fellow implant manufacturers Bristol Myers-Squibb, Baxter Healthcare Corporation, and the Minnesota Mining and Manufacturing (3M) Company also faced numerous suits. I was finishing middle school or entering high school when my mother received a letter notifying her of a class-action suit against the manufacturer of her implants and letting her know of her right to join the fray. Although she felt livid—enraged—that these devices had not been adequately tested, she declined to join the suit, since she hadn’t personally experienced any adverse effects. In 1998, Dow settled what was then the largest class-action lawsuit in history, agreeing to a multibillion-dollar payout to tens of thousands of plaintiffs, even though no conclusive link between silicone implants and autoimmune diseases had been found. In fact, many years of science—including at least seventeen separate studies—has concluded that women with implants develop autoimmune diseases at the same rate as the normal population, although the FDA cautions that longer studies are still needed. Fourteen years after the original ban, in 2006, the FDA again approved silicone implants for reconstruction and augmentation.
The aim of all these strange materials, from wax to silicone to fatty tissue is, of course, to create a better breast. To the women who have them, breasts mean many different things—food for infants, markers of femininity, annoying things that get in the way of exercise, erotic sensation-givers, signifiers of adulthood, and aesthetic objects that look good in certain necklines. Plastic surgery concerns itself primarily with the last. The better breast, the ideal breast, is beautiful both clothed and unclothed. If beauty lies in the eye of the beholder, as the old saying goes, then the beholder is most often a male plastic surgeon, who has been historically inclined to condescend to his female client.
One 1976 plastic surgery textbook on breast reduction explained how they’d decided what “normal” breasts looked like. They took 150 healthy women and measured their breasts with their arms at their sides. “Of these, 20 were selected as being aesthetically perfect, or nearly so. They were regarded as normal,” the book noted. Ah, the conflation of “perfect” with “normal”—so emblematic of American culture. If it’s normal to be perfect, then most of us are freaks in need of plastic surgery. Also this construction of “aesthetically perfect” relies on the preferences of the people making the selections. If we’d gotten King Henry VIII to make the assessment, he’d probably have chosen the tiny-breasted. Even nowadays, both women and men have a variety of preferences—some view big breasts as ideal; others don’t. It seems bizarre to consider less than 20 percent of the volunteer sample “normal.” Since these ladies had similar breast dimensions that didn’t vary according to height and weight, obviously “there exists a standard type of breast whose measurements would be aesthetically correct for any woman.” One surgeon in the textbook went so far as to suggest that women shouldn’t have a say in the size of their new racks because “they are far too emotionally involved.” Oh, those crazy women, with their feelings and thoughts and desires about what sorts of surgery other people should perform on them. Decisions about breast size obviously require the superior judgment of men. Because who knows more about what it’s like to have breasts than someone without them? Florence Williams, author of Breasts: A Natural and Unnatural History, reported that this literalization of the male gaze, etched into actual female bodies, stretched all the way back to the inception of silicone implants. Frank Gerow, half of the team behind the first Silastic implant, “reputedly liked big breasts, and apparently it wasn’t unusual for him to take a look at an unconscious woman on the operating table in whom he had just placed implants, decide she could handle bigger ones, and redo the whole thing.”
I’m not the sort of woman who dreamt of plastic surgery. I find the whole notion rather problematic, of expanding one’s body to fit the prevailing trends rather than fighting for an enlargement of what counts as normal and beautiful. As a feminist, I find the idea that I must pluck, tuck, resurface, and slenderize my body abhorrent. Yet, I do many of these things because I have internalized our culture’s body shame to such an extent that I feel I must do them to make my body acceptable to myself as well as others. Such beauty treatments construct a veil, a mask between me and the world, a false front that bricks my true self off, hides it in a secret compartment accessible only to me and a few permitted others. Yet the longer I wear the mask, the more it becomes me. Pay no attention to the woman behind the curtained black bangs. My constructed façade—cartoonish haircut, black-and-red uniform, fake breasts—is passably attractive. The real me, the secretly ugly me underneath the expensive makeup and concealing drapery—no longer feels like the authentic self it once did.
I wasn’t always like this—before I cut off my bre
asts, I had some fight against the prevailing beauty standard left in me. But after submitting to the surgeon’s gaze, after I received the eternally perfect bosom I never wanted, suddenly, it all seemed within my grasp—the ageless face, the hourglass figure, a flawless complexion achieved with neurotoxins, liposuction, and chemical abrasion. Before my surgery, I neither plucked my eyebrows nor shaved my legs regularly. I scoffed at plastic alterations—I am me, I am my body, and I am as good as anyone else just as I am. After my surgery, I fantasized about quick fixes to all the things I hated—my saddle bags, my spare tire and my angel wings, the incipient crow’s feet, the jowly cheeks and loose under-neck beginning to emerge, even at thirty-one. I might have been young, once, before this ordeal, but now I feel old, trapped forever in a body with a youthful chest, the rest of me doomed to wilt and fade. I’m Meg’s granddaughter, insecure about my appearance, worried that everyone who looks at me thinks about my mastectomy or thinks me vain for the surgery I never sought, anxious about the lie my faked cleavage presents to the public. I had a body, once, a natural body that existed in the world, but plastic surgery changed it. And in changing my body it changed me.
10 | Captain Kirk and Doctor Spock
I lost control of my body. In the six weeks after I learned of my BRCA mutation, I gained fifteen pounds—a shade over 10 percent of my body weight, and it was not on the wane. I was an undisciplined emotional eater, feasting on fatty cuts of stewed beef, baked goods smeared with cheese, ice cream, and cocktails. The reason I gained the weight wasn’t a mystery, but my inability to pause my ravenous appetite, to eat carrots instead of pasta, to even attempt exercise, well, I found it curious. I had no spare energy with which to exercise self-control; all my energies had funneled into grief. I outgrew my pants and had to buy bigger ones. I ballooned out of those, and pride wouldn’t let me size up again—I let the arbitrary number on the tag make me feel inadequate. It was part of how I punished myself for my feelings. I decided pants were a privilege of the thin, a class I no longer belonged to. Lately, as a function of the deaths in my family and my dark mood, I had been feeling the black clothing anyway, and I deceived myself into thinking that if I wore dresses, that if I wore black—it’s slimming!—no one would notice.