Stamping Out A Dread Scourge

In the spirit of a public health campaign, the American Society of Plastic and Reconstructive Surgeons (ASPRS) has launched a p.r. drive to "tell the other side of the ((breast-implant)) story." Public health? Slicing women's chests open so that they can be stuffed with a close chemical relative of Silly Putty? Yes, indeed, because the plastic surgeons understand what the FDA is so reluctant to acknowledge: small breasts are not just a harmless challenge to the bikini wearer or would-be topless entertainer. They are a disease, a disfiguring illness for which the technical term is micromastia.

As the ASPRS tried to explain to the FDA almost 10 years ago, "There is a substantial and enlarging body of medical information and opinion to the effect that these deformities ((small breasts)) are really a disease." Not a fatal disease, perhaps, to judge from the number of sufferers who are still hobbling around untreated, but a disease nonetheless, like the flu or TB. And anyone tempted to fault the medical establishment for inaction on breast cancer or AIDS should consider its quiet but no less heroic progress against the scourge of micromastia: in the past 30 years, 1.6 million victims have been identified and cured. Who says our health system doesn't work?

Once we understand that small breasts are a "disease," it's easier to see why Dow Corning and others rushed so breathlessly to get their implants onto the market. Why diddle around with slow, costly tests while an epidemic is raging out there? And everyone's life is touched by the tragedy of micromastia because everyone has a friend, sister, co-worker or wife who falls pitifully short in the mammary department. In the past, small groups of health-conscious males, typically gathered at construction sites, would offer free diagnoses to women passersby, but there was little that could be done until the advent of the insertable Silly Putty breast.

Admittedly, micromastia is in some ways an atypical disease. It is painless, which is why many victims put off treatment for years, and it in no way diminishes breast function, if that is still defined as lactation. The implants, on the other hand, can interfere with lactation, and they make mammograms less able to find cancer (not to mention the potential for a disfiguring or life-threatening side effect like lupus or scleroderma). But so what if micromastia has no functional impact? Why can't a disease be manifested solely by size?

Consider the rigorously scientific methods employed by the medical profession in its efforts to curb the epidemic. Not just anyone could get breast implants. No, the doctor had to study the afflicted area first to decide whether they were truly needed. For example, a friend of mine, an ( inquiring journalist of average proportions, called a New York City-area plastic surgeon to ask about implants and was told to come in for an exam. One quick, searching look and he told her yes, she needed them, badly.

In fact, according to the rumor mill, Jessica Hahn may have needed them too, as may have Melanie Griffith, Jane Fonda, Brigitte Nielsen and even, gasp, Dolly Parton. Why take chances? The doctors know there are not only obvious forms of micromastia, discernible to the man on the street, but insidious, hidden forms -- very well hidden indeed.