In the last 10 years, the number of women undergoing breast augmentations has increased dramatically. During 2007, nearly half a million women opted for this form of elective surgery. Many seem convinced that breast implants are an easy way to shore up their self-image. As one woman put it, “I got implants so that I could gain back my confidence and feel good about myself.” The growing popularity of this kind of plastic surgery, however, raises a constellation of health concerns, ethical questions, and personal/spiritual issues that may need to be confronted whenever the temptation to pursue elective breast augmentation arises.

As a general rule, there should be a compelling therapeutic reason whenever we elect to undergo breast augmentation, because surgery and anesthesia always involve risks. Breast implant surgery is not considered “therapeutic” in the traditional sense, except for women who have undergone a mastectomy, or otherwise suffered significant breast damage, in which case the procedure may indeed represent a reconstructive or restorative therapy. Implants, of course, are serious business -- real surgery with real side effects and strange things that can go wrong. Such implants can rupture, have capsular contractions, or develop leaks. Moreover, they are clearly not a permanent solution. They need to be replaced periodically. The decision to get implants, particularly at an early age, is an almost certain guarantee of more surgeries later on.

Choosing to increase the size of otherwise healthy breasts raises a number of health-related concerns -- and ethical concerns as well. Implants may increase diagnostic difficulties associated with doing mammograms. Some women report that implants make self-examinations harder. In the past, implants were often filled with silicone, and when they would rupture, some women developed immune conditions and health problems which were attributed to the release of silicone into their bodies. Implants and implant surgery can also affect the purpose and proper functioning of the breast, by causing lactation insufficiency and other complications associated with breast-feeding.

Women who feel a strong need to augment their breasts may also be struggling with deeper personal and spiritual issues regarding their own self-image. All of us are keenly aware of the way that people react to us when they first meet us, and whenever they respond negatively to our appearance, it can damage our self-esteem. In our society, attractive people often end up receiving preferential treatment, and this seems especially true for women. The result is a peculiar kind of pressure on women: on the one hand, they are valued for their beauty and feel compelled to conform to the societal ideal. On the other hand, elective breast augmentation seems to go too far in an effort to meet that ideal. It seems to cross an ethical line by saying that women should alter their healthy bodies in very radical ways in order to conform to what is portrayed on television or in glossy women’s magazines. The escalating use of pornography among men may also be contributing to this pressure to conform to the digitally enhanced and hyper-sexualized images of the computer screen. As one woman put it, “If you have friends who gossip about your flat chest, you need new friends, not new breasts.” In the face of so many disordered and unreasonable pressures, undergoing an augmentation may even be construed as a form of unethical self-mutilation in the name of some other perceived good.

A further difficulty is that such surgery frequently does not address the real self-image problems that a woman may be struggling with. Some who pursue this so-called “plastic perfection” may be prone to self-discontentment to begin with. Aiming to make one’s body match up to an external, visual measure of beauty can seem to open up a new level of attention and affirmation from others. But it can also lead to a shallowness and an unhealthy self-focus. I recall the story of a young man who got seriously involved with body-building and weight lifting. He worked many long months to build up his muscle tone and bulk up his physique by working out on various exercise machines. Soon he realized that his focus had become so intense that it had managed to turn into a completely self-centered behavior, so that whenever he would pass by a mirror he couldn’t help flexing his muscles to see whether they had gotten any larger since the last time he checked. A similar self-centeredness and vanity can arise in the woman who focuses too much on her figure or her profile.

After doing an augmentation, there can be a “honeymoon period” where a woman may be pleased with the outcome, following which she can easily reset to a new baseline of unease and discontent. She may need to get yet another surgery, another shot, or another treatment only to find that none of it “fills the void.” It is always possible to fixate on something else that needs changing before we will allow ourselves to feel good about who we are and to accept what we have been given. There is often something embarrassing, perhaps even scandalous, in the realization that women really want to do these elective procedures. The psychological flaw here, one might argue, is even uglier than any perceived chest size “flaw.” A negative self-image can be very tough to overcome, and implants too easily tempt with a kind of false answer.

Ultimately, faulty notions of beauty are likely to be at play as well in these debates about breast implants. I think it was Albert Einstein who remarked that beyond what we perceive with our eyes, “there is something that our mind cannot grasp and whose beauty and sublimity reaches us only indirectly.” The temptation to reduce feminine beauty to a kind of plastic and exterior measure is surely a failure to realize how a woman’s physical beauty is meant to be but a gentle hint, a pointer towards an abiding beauty within. Her outside image will have some relationship to the woman she is and wants to be, but that exterior image is necessarily partial and incomplete, and should spur every woman to pursue and develop that deeper feminine beauty and virtue that is properly found within.

Father Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the Diocese of Fall River and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org