The mutilation of beauty

We live in an age when large breasts are preferred but women who turn to surgeons are yielding to vanity

When healthy women deliberately inflict wounds on themselves, it is called scarification. It happens in women's prisons, where it is interpreted as a sign of emotional disturbance. Yet when healthy women pay a man to cut into their breasts, it is called cosmetic surgery or a boob job, and they are congratulated on their new cup size. Last week, British women who have "natural" soya breast implants were advised by the Department of Health to have them removed. They were also told they should not become pregnant or breast-feed until they have been taken out.

When healthy women deliberately inflict wounds on themselves, it is called scarification. It happens in women's prisons, where it is interpreted as a sign of emotional disturbance. Yet when healthy women pay a man to cut into their breasts, it is called cosmetic surgery or a boob job, and they are congratulated on their new cup size. Last week, British women who have "natural" soya breast implants were advised by the Department of Health to have them removed. They were also told they should not become pregnant or breast-feed until they have been taken out.

Soya has been used as a "safe" alternative since 1995, but it has now been established that there is a danger of seepage - oil from the implants leaking into the body where it may break down into aldehydes, which are potentially carcinogenic. The majority of patients, 85 to 90 per cent, opted for the operation not because they had had a mastectomy but to improve their appearance. The cruel word for this is vanity, although both patients and surgeons are offended by it. Theirs is a world ruled by euphemism, in which consultants call themselves "aesthetic" surgeons and talk soothingly about breast "augmentation". It certainly sounds more pleasant than having your breasts sliced open and filled with a non-metallic element used in the manufacture of glass (silicon), salt water or cooking oil.

Someone one told me that silicone (a compound of silicon and oxygen) survives cremation, which conjures up a macabre picture of bereaved relatives receiving not just their loved one's ashes but her implants. I bet it already happens in California. One morning last week, when I described breast enlargement as a form of voluntary self-mutilation on a BBC phone-in, there were immediate protests. Women called in to say they had chosen it freely, and were delighted with the result. A plastic surgeon in the studio pointed to my hair and remarked that we are all slaves to fashion. Hello? Planet Earth calling: I have my hair cut every six weeks and it has never involved a general anaesthetic.

Ninety per cent of plastic surgeons are men. Eighty-five per cent of their patients are female. This really is a job for men who operate, especially in the private sector, on women who have nothing wrong with them except an anxiety about their appearance. We happen to live at a time when large breasts are desirable, but there have been decades when women aspired to a flat-chested look - the Jazz Age flapper, or Twiggy in the 1960s. Obviously some women are born at the wrong moment, but that is not a justification for thinking about the female body as a branch of haute couture, as easily altered as a hemline.

THE FACT that such operations are becoming routine should not conceal their purpose, which is conforming to a transient ideal of beauty. Doctors don't encourage anorexics to diet down to their fantasy body weight, so why are surgeons so cavalier about giving women fantasy breasts? In the 19th century, plastic surgeons were frequently asked to disguise racial characteristics, to make noses look less Jewish or lips more Caucasian, so light-skinned black people could pass for white. No one would suggest this tragic response to racism was healthy, and I don't see why we are expected to regard breast enlargement any more benignly.

In the medical profession as a whole, women make up 33 per cent of hospital doctors but only 21 per cent of consultants. The balance is no better in obstetrics and gynaecology. It emerged last week that Rodney Ledward, the disgraced gynaecologist, is entirely unrepentant, and claims he was a "first-class consultant". Another gynaecologist will appear before the General Medical Council next week, charged with performing botched operations and falsifying records.

Mr Ledward clearly had little respect for the women he treated. I am not suggesting that all male surgeons are incompetent, but the shortage of women consultants is disturbing. Men cannot help regarding the female body as "other", and it is hard to resist the notion that cosmetic surgery attracts doctors who have a Pygmalion fantasy lurking somewhere in their psyche. Too many of them are happy to treat perfectly healthy women, snipping a bit off here, adding a bit there. I wouldn't let them near my tonsils, let alone a sensitive part of my anatomy like my breasts.

In a recent article in the New Statesman, Andrea Dworkin described how she was drugged and raped in a hotel during a visit to Europe last year. She recalled ordering a drink that tasted odd, stumbling upstairs to her room and passing out. When she came round, her body was bruised and she was bleeding from gashes on her leg. Ms Dworkin, a brave and formidable feminist, believes she was raped while she was unconscious by the barman and an accomplice.

My first reaction on reading the article was horror. I have seldom read anything that conveys someone's anguish so graphically. But then I read it again, and details began to puzzle me. Why did Ms Dworkin's gynaecologist in New York react so unsympathetically when she rang for advice? Why does she say she sometimes feels deserted by her long-term companion, a gay man who has always supported her loyally in the past? This is not at all to suggest Ms Dworkin's distress is not genuine, or that she did not have a devastating experience. The fact that she did not call the police or a local doctor may be a consequence of shock, although it also means there is no medical evidence, such as traces of a drug in her blood, that might help explain what happened in the missing hours.

Ms Dworkin has devoted much of her adult life to a campaign against pornography and the damage she believes it does to women. So I have always felt uncomfortable with the graphic scenes of sexual violence against women in her novels: it is as though she has become addicted to the thing she hates, compelled not just to denounce it but to reproduce it in her own fiction. Nor could I help noticing a disturbing similarity between her account of the real-life rapes and some of those scenes. In her article, she imagines the assaults in almost masochistic detail, dwelling on the attackers' motives and their loathing of her.

Of course I don't think that only young, slender women get raped. Nor do I believe that Ms Dworkin has invented the attack. On the contrary, her account of its effect is gut-wrenching. At the same time, I am worried about the way she has filled in the missing elements when she can never know for certain, given that the men she suspects have never been interviewed by the police. It seems tragic both that she was unable to summon help, and that she is torturing herself with the notion that only her very worst suspicions can represent the truth.