Entering the office of a cosmetic surgeon  on the top floor of a high rise is like entering the showroom of Breasts 'R' Us. In one corner stands a small bronze figurine of a Native American maiden, her chest thrust forward aggressively, nipples erect. On a wall, Venus emerges naked from the sea in a reproduction of Botticrlli's painting. Reading matter includes a powder-blue brochure in which 16 different women bare their chests  both before and after their implant surgery. Before your eyes, small breasts bloom into big, bigger or huge ones.

Big Breasts Are Big Business

 At the Breast Enhancement Medical Center, big breasts are big business. Doctors have slipped silicone pouches into the bodies of thousands of women, turning underformed AA, A and even B cups into voluptuous Cs and Ds. Ads seeking new business run regularly in the newspaper: Do you identify with one of these women?, asks copy under a picture of three scantily clad torsos, two busty, one flat. Any small-breasted woman who answers yes has only to make a phone call. The doctor offers free consultations.

In a small examining room, a woman changes into a smock, and is left alone to dream of how breast augmentation surgery might change her life. Before her is a photo album with more 'before and after' shots. On a nearby wall are framed, handwritten testimonials, presumably from the doctor's patients. "I feel so feminine and daring now!," declares one. "A million thanks for transforming me into a woman of the 90s!," says another. Breast enlargement, suggests the brochure, can build a womans self-confidence and enhance her sexuality.

 A small-breasted woman -- moreover one who grew up with proudly exhibited flesh all around her -- is not immune to this. Yes, she would like to be shaped like one of those voluptuous goddesses she's seen around her all her life. She'd love to buy a bathing suit without getting depressed, or walk into a room in a strapless dress, knowing heads will turn. She doesn't have to settle for just wanting these things, the doctor suggests, she could have them. Genial and reassuring, the doctor prods the womans chest for ten seconds, then pronounces the tissue heathy enough for surgery. Breast augmentation, he says, might not turn her into a centerfold, but some women find it the "biggest trip of their lives." Surgery could take place within three weeks. (There's a six-week wait in summer; big breasts become more important then.) The operation is an hour long and is followed by three days of rest. There will be discomfort but no pain.

 "Is this safe?," every woman questions.

"Let me put it this way," says the doctor, who is in his 50s, "both my wife and daughter have implants, and I'm not worried."

 The doctors sales pitch is low-key. He doesn't encourage a woman to have the procedure, nor does he give her the details. But she quickly finds out from his staff just how easily she can achieve this dream: $4,200, credit cards accepted, financing available.

Millions of American women have had breast-augmentation surgery. Among the most affluent, body-conscious women, as many as one in five has had breast implants. About 80 percent seek a purely cosmetic change; they simply want larger breasts.

For most women, the "devastation" of small breasts doesn't last beyond the teen years. But for some, such as Branice, grief over a flat chest persists into adulthood. Without full breasts they feel they have failed to make the crucial transition into womanhood. In fact, the typical implant patient seeks surgery because she has real doubts about her essential femininity.


Psychological Benefits

The psychological benefits are remarkable; the surgery really does seem to change women's lives. Often women who've had augmentation are ecstatic. Augmentation surgery is "psychologically superb." Most women reported that after surgery their sex lives improved, and almost all felt better about themselves. The over whelming majority of the augmentation patients would choose to have the procedure done again.

Absolutely No Feeling

The improved sex lives and confidence came despite the fact that many women reported suffering some degree of capsular contraction, alterations in nipple sensation and serious scarring. Two months after her operation, one woman couldn't feel her chest at all. "I have no sensation, and it's kind of weird," she said, sounding untroubled. "I brush up against things and there's absolutely no feeling. That's supposed to subside over the next six months."

In the end, looking like a sexual woman is more important than responding like one. If the sensation in her nipples never comes back, this woman says, she will still be happy. "I had years of breast stimulation, and it was great," she says. "But right now I'd rather look good and feel good about myself than have that momentary pleasure."

What has our culture done to women that makes us want big breasts so desperately? Not surprisingly, feelings of inadequacy usually begin in adolescence, a time when the appearance of breasts offers a girl proof that she's turning into a woman.

All through my teens I was absolutely flat, recalls Theresa, a 36-year-old hairstylist who had augmentation surgery at age 22. "All I wanted was to wear the same kind of bra my friends did. My mother laughed when I bought myself one. I was devastated."

Ironically, it isn't individual men who create these doubts. "I never had any trouble getting boyfriends, and no man had ever said anything negative to me about my breasts." say Debra Wilson, age 38, a mother and small-business owner who had surgery in 1990. Ambrose adds bluntly, "My husband loved my little boobs. He was perfectly happy with me the way I was."

Women who have breast augmentation say they would do so even if their spouses and family members were opposed to the surgery; larger breasts are something they say they want. And when they talk about the distress they felt for so long about their bodies, they describe it as being utterly personal. "It wasn't anything anyone else said or did, the problem was me," says Connie, a 34-year-old recently divorced homemaker and mother of two who had her operation in late 1991. "I'd just look at myself in the mirror and ugh, she says emphatically. "I thought that finally making this change went hand-in-hand with exercise and eating well and feeling good about myself in other ways. I did it for my own self-confidence and self-esteem. It was for me."

But the idea that desire for a bigger bust line can be completely rooted in an individual woman's psyche makes a professor of history who specializes in women's history, shake her head in astonishment.

"When a woman says, 'I've chosen breast implants for me,' it’s as though she's unaware of the ways in which the culture influences her about the way she looks -- and to believe she'd feel happier if her breasts were larger."

Clinical psychologist, a member of the FDA panel on breast implants and the author of Body Love, agrees. American women worry obsessively about their breasts, she says, because American culture "neurotically worships busts out of all proportion to their importance."

No one has to look ar for evidence that in this culture having full breasts is what is considered attractive. For years, of course, skin magazines and pinup posters have equated sexual desirability with having big breasts. Clothing commonly devined as sexy -- strapless and low-cut dresses, provocative lingerie -- has always emphasized the bust. But more recently, the adoration of big breasts has spread to mainstream media images. "In 1988 the standard mannequin gained almost 3 inches in her breasts," she says. "Designers began parading out a vision of women that was thin and busty at the same time. This is a physical impossibility, so one model after another got breast implants. The lingerie industry began proclaiming that breasts are back, that the average woman now wore a 36C rather than 34B." The result: startlingly large mellon-like breasts on slender models.

In fashion, movies and advertisements, the images of breasts that women see are of only one type -- upright, idealized, perfect. These perfect breasts send out a powerful message to the women who see them: Only big-breasted women are desirable; only one kind of breast is the right kind. That message is repeated so often -- according to one study, the average American sees between 400 and 1,400 advertising images each day, many of them featuring large breasts -- that we become blind to it. When everyone "knows" that a certain body type is more attractive than others, it's easy to forget that the preference is learn, not innate. "The pressure women feel to meet an ideal is so pervasive that it almost becomes invisible." says Rosen. "I'm not sure most of us realize how much we are influenced by it."

Deformities [Small Breasts]

Because we connect large breasts with sexual desirability, unhappiness with our bodies often takes a specifically sexual focus: Since the images a small-breasted woman sees around her say that she doesn't look sexy, she doesn't feel sexy. If failure to have the right body causes a woman grief, she can just change herself. Certainly the notion that a new look equals a new self has been encouraged by cosmetic surgeons, who bill "body sculpturing" as safe and affordable -- even necessary. Some called flat-chestedness a disease. If left uncorrected, noted a statement from the society, "these deformities [small breasts] can cause a total lack of well-being."

Individual doctors picked up on this theme -- "There are some things in life you just can't change," declared one surgeon's ad. "Your looks used to be one of them." "Body by Dr. Stephenson" said another, displaying a beautiful, bathing-suit-clad model next to an expensive sports car.

The media followed suit. Breast surgery claimed one magazine article, can provide "an enhanced sense of your own attractiveness." Augmentation, said another has "helped some of America's most beautiful celebrities and socialites become their own best fantasies." Partly as a result of such endorsements, the number of breast augmentations went up sharply. And the more women who had the surgery, the more pressure there was on other small-breasted women to follow. The kind of woman who opted for surgery changed too. Although for years cosmetic surgery was reserved for the wealthy, a recent survey found that fully one third of implant patients had an income of $25,000 a year or less.

Dozens of satisfied customers testified before the FDA panel, pleading with them to keep implants available, despite the lack of evidence about the safety of the devices.  

Women are urged to ignore the FDA's moratorium -- from one of the doctor's assistants. "Thank you for taking the time to come into our office and meet with the doctor," the note said. "He enjoyed meeting you very much. Please call if you have further questions."

Further questions are what anyone might have. Certainly we live in a world in which looking good matters. But there's a line between wanting to look good and hating ourselves.

Given the images we've been bombarded with for the last ten years, it's not surprising that a lot of women feel they're not worthy of sexual pleasure or sexual attention if they don't have augmentation," says Wolf. "I don't condemn anything a woman does to make herself feel good. Women have the right to do anything they want with their bodies and that includes having surgery.

But I do believe in choice. That means understanding that when all models have implants and we compare our bodies to theirs, we're comparing ourselves to manmade objects. Choice also means being able to choose not to have surgery -- and still be able to feel good."