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The waiting rooms of plastic surgeons hardly resemble those of traditional doctor’s offices. Instead of fluorescent overhead lighting and plastic chairs, they have patterned wallpaper, wood floors and floral arrangements. In the autumn of 2019, I waited for one consultation on the Upper East Side under a crystal chandelier, beside a minifridge where patients could help themselves to petite bottles of Diet Coke and Perrier. Another had crimson window dressings, marble tables and red upholstered chairs, a boudoirish setting that both disconcerted and comforted me. This was the office I decided to return to after my initial consultation.
On my second visit, I was grateful to find the exam room was the standard medical white, with its crinkly papered table and glass jars. The surgeon joined me, accompanied by a wordless young female assistant with immaculate makeup. He was tall with a sort of lewdly handsome face — full, pink lips and sleepy blue eyes. I was learning that my preference was for surgeons whose looks struck a dry and sexless note.
The silent woman handed me a gown and gestured to the curtained corner of the exam room. It was absurd to disrobe behind a curtain and don a robe simply so that I could walk out from behind the curtain and open the robe for him to examine me, but I still appreciated the theatrical privacy. My breasts hadn’t been touched by a man in a very long time and had never been studied by one under such harsh light, or any light at all without the mediation of desire.
I stared at a random spot on the wall as I stood with the robe open, my naked breasts prickling under his scrutiny, my mind willfully blank. His study complete, the surgeon snapped a photo with a camera that he plugged into a desktop computer. My torso appeared on the screen like a disassembled mannequin, bright against a black background.
My breasts were even bigger than I imagined them: teardrop-shaped with wide purple nipples. As the surgeon moved his computer mouse, they changed shape. With a twitch of his finger, they rose on the disembodied torso and shrank into the breasts I had fantasized about for more than 25 years.
Until age 11, I was a confident, athletic child. Tanned and strong, I played barefoot all summer in our rural New England neighborhood and took pride in the bruises and scrapes that mapped the days across my limbs. Then, my breasts arrived: huge, heavy and first among my peers. They marked the before and after of my body — what it meant in the world of people and what it meant to me.
My transformation inhibited me both physically and socially. I couldn’t run anymore, partly because it was uncomfortable — sports-bra technology had not developed enough to bind a chest like mine on a body my age — but moreover because I could not be seen running. I stopped playing sports, stopped playing outside altogether. Worse, I was dogged by boys and loathed by girls and soon developed a reputation as a slut. At first, this was solely because of my breasts, but it worsened when I reluctantly yielded to the boys who wanted to touch them. Sexual attention could be alluring, but the specter of pleasure was a mirage. Afraid to rebuff that which I’d invited, I consented to acts that overwhelmed me and was relentlessly harassed at school.
Over the next 25 years, my breasts drew attention that I would not otherwise have received. Like a sexual beacon, they signaled to men everywhere. I’d always known I was queer and began dating women as a teenager. While I found some refuge in these intimate relationships, I still lived in the world of men, and the size of my breasts meant that my body was theirs for the staring, commenting, grabbing and fetishizing. Most women contend with being sexually objectified but not all start at 10 or 11 years old. By the time I was 12, my body felt like a disguise that I couldn’t take off.
For most of my life, I desperately wanted my body to be different, and I also understood the obsession as a shortcoming — as a failure to be a real feminist. I thought that I needed to accept my body, to love my body and find it beautiful, to successfully reject the internalized messaging of the patriarchal culture. My shame signified a personal failure at this. It never occurred to me that my problem was also material and social. I could accept and love my body entirely and men would still yell at me out of car windows, grope me in public, make assumptions about my intelligence and sexual availability. My perception of myself could never be entirely sealed off from other peoples’ perceptions of me.
In the Diagnostic and Statistical Manual of Mental Disorders 5, body dysmorphic disorder is classified with other obsessive-compulsive disorders and defined as a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.” B.D.D. “causes clinically significant distress or impairment in social, occupational or other areas of functioning.” The definition of the word “dysmorphic,” however, elides the element of misperception. Its origin is the Greek dys- (bad, ill, difficult, abnormal) and morphē (form, shape). Though the words are often used interchangeably, it is a crucial distinction: to suffer from a misperception of the body as malformed and to suffer from a malformed body. One is a pathology, the other a practical condition. In a way, I suffered from both, though the category of malformed bodies becomes more opaque the closer you examine it. It becomes possible to see a body’s malformation as that of the society it inhabits.
In 1993, People magazine featured Soleil Moon Frye, former star of the television series “Punky Brewster,” on its cover. “Teenage Plastic Surgery” read the headline. Frye, who was just three years older than I, had gotten a breast reduction, going from a 38DD chest to a 36C. “I couldn’t sit up straight without people looking at me like I was a prostitute,” she told the reporter. “I am just loving myself right now. I’m finally free to be the teenager that I am.” Frye and I were the same height, but her breasts were larger than mine, which were a 36D.
Though I would have given anything for the freedom to be the teenager I imagined I could be with smaller breasts, I did not even consider the possibility of a breast reduction. I was certain that I would have needed a “real” deformity to justify even entertaining the suggestion. Frye’s size apparently qualified: gigantomastia, the magazine called it. No, I was sure it would have been the ultimate act of body hatred, a self-mutilation on par with any other form of pathological self-harm. Not to mention the frivolous expense; my family was not rich.
I grew up in the 1980s and ’90s, thumbing through my mother’s issues of Ms. and occasionally attending NOW meetings with her. Despite never having read any feminist writing on cosmetic surgery, I knew that the consensus was, as Kathy Davis, the foremost contemporary feminist theorist on the subject, wrote in a 1991 article in the journal “Hypatia,” that cosmetic surgery was “regarded as an extreme form of medical misogyny, producing and reproducing the pernicious and pervasive cultural themes of deficient femininity.” The woman who yielded to the desire to commit such violence to her body was a “cultural dope,” afflicted by false consciousness, believing she made a personal choice while actually yielding to a system that controls and oppresses women.
When I was 15, a friend’s mother took us to see Gloria Steinem speak at Brandeis University. During the Q. and A., a trembling young woman stepped up to the mic and asked Steinem if it was OK for feminists to shave their legs. Steinem, who had giant glasses and a chic blond bob, laughed warmly and told the audience that she was often asked this question. She said that foundational to feminism was the belief that women ought to be able to do whatever they want with their bodies. Relief washed through me. I had already been tormented for years by the seeming conflict between my love for high heels and makeup and the second-wave feminist belief that such trappings were complicit in patriarchy’s oppression of women.
Years later, I found plenty of loopholes in my inherited feminism that permitted me to do things I would have thought off limits at 13, but none were big enough to fit cosmetic surgery. Even by my early 20s, the only people I knew who’d done it were friends who worked in the sex industry, for whom it seemed a professional investment rather than a personal one. I would need a more powerful kind of permission that I didn’t yet feel the authority to give myself.
The idea that my breasts weren’t irregular enough to warrant surgery has a history longer than mine. The distinction between respectable plastic surgery and “aesthetic” surgery has been made for almost a century. As the writer Elizabeth Haiken explains in her 1997 book, “Venus Envy: A History of Cosmetic Surgery,” the modern practice of plastic surgery didn’t really begin until it was “reborn” after the First World War “as an art and a profession.” Practitioners said it was a medical response to the crisis of warfare and “chose the term plastic surgeon to distinguish themselves from the practitioners they called ‘beauty doctors’ and claimed the term plastic surgery to differentiate their work from what they variously called ‘featural,’ ‘beauty,’ ‘cosmetic’ or ‘aesthetic’ surgery.” They didn’t want to be mistaken for the doctors who advertised in the backs of women’s magazines and experimented with paraffin injections — a precursor to contemporary fillers that yielded catastrophic results.
One clinical professor of surgery at Johns Hopkins stated in 1927 that “a beauty surgeon works strictly on a commercial basis” and saw the patient’s personal satisfaction as the only yardstick by which his work was justified, whereas the plastic surgeon “would be willing to operate only when the deformity was sufficient to justify it, and when he knew there would be real improvement.” It was, in other words, a noble service to reconstruct wounded soldiers’ faces but a disgrace to alter the bodies of women who had not been deformed by such crises. Being an ugly woman, or simply a woman who experienced her body dysphorically, was not a crisis on par with battlefield disfigurements, disease mutations or congenital anomalies that had clinical names like a cleft palate or gigantomastia.
Surgery has always been a field dominated by men, and plastic surgery most of all. In 2020, the American Society of Plastic Surgeons estimated that women make up 92 percent of all cosmetic-surgery patients, while a 2017 study found that only 20 percent of board-certified plastic surgeons were women. It’s fitting that the most well-known autobiography of a cosmetic surgeon, published in 1953, is titled “Doctor Pygmalion.” Its author, Dr. Maxwell Maltz, characterizes himself as an aesthete and an artist. Like Ovid’s sculptor and Shaw’s Henry Higgins, he delights in his ability to shape women: “I could whisk new noses out of the air … just about everything lay within the compass of my magical powers.” The tone of his memoir reminds me of two of the most popular cosmetic-surgery-themed television series: the reality concoction “Botched” and Ryan Murphy’s “Nip/Tuck,” which both feature male surgeon duos who sculpt their female patients’ bodies with an eroticized relish. That it was, and continues to be, up to the most likely male surgeon to determine “when the deformity was sufficient” squares with our general belief in the expertise of trained doctors — though you can also see it as a way of prohibiting women (and later, the gender-nonconforming) from claiming sovereignty over their bodies.
We live in a visual culture, a culture whose hierarchies are most often assessed through the way we look. All I ever wanted was to lead with myself as I knew myself, not with my breasts and all that they connoted in the eyes of others. I wanted some agency in determining how I was perceived. I have since read this described as “bodily invisibility”: the privilege of accessing the world directly, without significant mediation or interference of others’ assumptions or biases against one’s body.
I knew that as a woman, I was permitted by social conventions to modify my body only in certain ways. I could get manicures, shave and wax off half of my body hair, maintain a hairstyle, exercise for hours daily and wear makeup. My conception of feminism also permitted me to cover myself in tattoos, pierce just about every flap of skin on my body and stretch inch-wide holes in my earlobes as well as have them sewn back up 10 years later (a permissible “deformity” to have corrected). To change my body through cosmetic surgery, however, would violate the often-conflicting ideologies behind these allowances. Elective surgery was unnatural and irreversible, perverting my God-given form in too extreme a fashion.
The supposed dichotomy between “medical” and “aesthetic” surgeries is reflected perhaps most starkly in today’s medicalization of sexual transition, the manner in which transgender people seeking surgery must pathologize their experience in order to receive permission from medical gatekeepers. Listening to the experiences of my trans friends and reading the works of trans writers pushed me to think differently about my own dilemma.
Julia Serano writes in “Excluded” that, “in our culture, feminine appearances are more blatantly and routinely judged by society than masculine ones. It is also driven by the fact that connotations such as ‘artificial,’ ‘contrived’ and ‘frivolous’ are practically built into our cultural understanding of femininity.” This particular form of sexism is instrumental in the trans-misogynistic double bind, wherein trans women are faced with the pressure (in addition to their own personal desires) to have surgery in order to prove their femaleness and assure their physical safety, while they are damned post-surgery for the perceived artifice of their gender. The process of laying bare the internalized prescriptions for what I should or shouldn’t do with my body began to strip them of their power.
In the winter of 2018, as my wife and I were driving home, I said: “There’s something I want to talk to you about, but I’m not ready yet. I just want to put it out there. I think I might be ready soon.”
One of the biggest reasons I hadn’t considered cosmetic surgery was that it would require an acknowledgment to another person that I suffered because of the way my body looked. The prospect of saying it aloud had always seemed unbearably vulnerable, an exposure of my own weakness. In my mid-30s, however, I had found myself considering it anew. I actually hadn’t thought about a breast reduction for years. I still experienced all the familiar discomforts: the exercise and fashion inhibitions, the phobia of any lover’s seeing me stand naked with the lights on, the fantasies that I might simply wake up with a transformed body — but I had grown used to accommodating and tolerating them. I still thought about my body a lot, but less than ever before.
Growing older had changed me. It was no longer important (or realistic) to strive for a particular kind of unattainable body. In my mid-30s, I could no longer choose to go hungry, nor exercise with my previous fervor without risking injury. Also, I cared little what men thought of me anymore. This, along with my age and the reduced frequency with which I dressed in clothes that drew their attention, was probably a factor in their lessening attention. I wasn’t sexually harassed on the street anywhere near as often as I had been in my 20s. I also cared a lot less what hypothetical fellow feminists thought of me, partly because I knew that I had few actual friends who would judge me if I decided to get cosmetic surgery.
One day, I simply asked myself: Would I do it if I didn’t have to explain myself to anyone? The answer was a resounding yes. Did I truly believe it would improve my life? I knew with gut certainty that it would. I had considered surgery an impossibility for so long, consigned myself to tolerating the discomforts. It took me a long time to change that way of thinking, although the realization happened instantly: I did not have to live with it. It seemed suddenly absurd that I had been privileging hypothetical people’s imagined opinions over my own daily ease and happiness.
The summer before I made the first appointment, my wife and I spent an afternoon in a private room at a bathhouse in Port Townsend, Wash., and that is where I told her about my decades-long struggle with my breasts and my interest in surgery. I had never spoken aloud about it to anyone. When I started talking, I couldn’t look her in the face, but that changed as our conversation progressed. She supported me entirely in whatever decision I made, she said. I felt immediately relieved. My fear had nothing to do with her, after all. It was the fear of that 11-year-old girl who had no words for her experience and had not found them for 25 years.
When I told her the story for the first time, I stood in a warm bath as steam rose around me. My voice echoed against the tiled walls. It felt like a kind of christening, my words naming something that had not fully existed before I spoke it and that naming had finally made mine.
It was a bizarre sensation, to look at my breasts for the last time. There would be some of the same tissue, yes, and a new nipple cut from the old one, but the breasts I had spent so many years wishing different, their particular weight, would be gone forever. In the surgical theater, the body is sacred only to its inhabitant. It did sneak up on me, the strange feeling of sacredness, as my surgeon squeezed and measured and scrawled on my breasts with a marker on the morning of my surgery.
When I had my earlobes sewn up at 32, I didn’t feel a thing — not physically or emotionally — until I stood up afterward and looked down at the metal tray of tools beside my surgical bed, where the little gray lumps of my earlobes still lay, like two chewed pieces of gum. “Oops,” the surgical assistant said. “I’m not supposed to let you see those.” She folded them in green paper that lined the tray, which she then crumpled and threw in the steel waste bin. It tugged something in me, maybe my body’s basic instinct to keep itself intact. I suddenly wished I had asked to keep them. On the morning of my breast surgery, I was glad I wouldn’t have to see my discarded parts thrown in the trash.
I was also glad for the sweet nurses, with their impeccably made-up faces and lilting voices. I was used to being in majority-female spaces, but these were often full of feminists, queers and trans and nonbinary people. The surgeon’s office was unabashedly feminine and steeped in the cozy assumption that everyone who entered was on the same page about beauty — how to define it and sure that they wanted it. Every time I stepped off the elevator, I felt like an interloper. If they had glimpsed my hairy legs, I would have felt guilty, exposed as a feminist Judas in deep cover.
I found it an oddly comforting space. The implicit consensus precluded any tension in the atmosphere, and I found that I had no desire to challenge the doctor when he said things like, “They’re going to be so much perkier and more youthful,” or when one of the nurses squeezed my wife’s shoulder and promised her, “You’re going to love them!”
Which is all to say that the culture of cosmetic-surgery offices, and perhaps the industry as a whole, aligns with the second-wave feminists’ take: an endorsement not only of patriarchal beauty standards, but of patriarchal social structure. I understand the temptation to extend this assessment to the patients who elect to participate in the industry. But while writing this essay, I spoke to a number of self-proclaimed feminists who felt no loss or regret about their surgeries — from thigh lifts to tummy tucks to vaginoplasty. Over all, the prevailing emotion was one of triumph and pleasure. It seems clear to me now that any feminist position on cosmetic surgery that doesn’t take women’s relationships to their own bodies into account actually objectifies them.
I’d hated my body for years, felt both obscured and exposed by it, and subjected it to many acts that others wanted irrespective of my desires. These cumulative burdens had consumed an inestimable amount of time and energy. In large part, they had defined my relationship to myself. All the years of therapy and recovery and writing and reading and conversations with friends had changed that. I no longer hated my body. My experience in the world no longer felt so defined by my corporeal form. To physically change my body felt like an important way to concretize that work. It was not, as some might assume, a substitution for psychological change but rather a physical consummation of one that had already taken place: a ritual commemorating my reclamation of my body, once and for all. I didn’t want it to be a subtle process.
Despite the consideration of women’s lived experience with cosmetic surgery, feminist theory still largely considers it problematic, a way of trading one terrible suffering for a less terrible suffering — the choices being to continue to live in a body that feels unbearable or to undergo an abhorrent violence. The assumption is that no one would choose bodily violence unless it was to alleviate unbearable suffering.
This is simply not true. I say this not only as a former professional dominatrix, but as a person who has long understood that most forms of healing include hurt and many include violence. As one often hears in 12-step meetings, “pain is the touchstone of all spiritual progress,” and chosen pain should not be mistaken for self-hatred.
While writing this, I had a conversation with a friend who suffered from dysmorphia as an adolescent and described having a face that drew negative responses from people her whole life. She decided to undergo elective facial reconstruction in her late 30s. She told me: “I wasn’t concerned with the improvement so much as I was concerned with having a literally violent, cathartic experience where I would go through a tremendous amount of pain and reconfiguration. And by doing that, I would reclaim ownership of my body and of my face from every single opinion about it.” In her words, I recognized an element of my own experience. My surgery had not only been a medical process but also a spiritual one, and the violence of it had been key to that. When I fasted the morning of the surgery and donned the surgical gown, it felt ceremonial, a rite marking not only a physical change but a metaphysical one.
My wife and I remember the days of my convalescence after surgery like a fabulous vacation, because never on any of our vacations have I relaxed to such an extent. Perched in a nest of pillows on our couch, I sipped seltzer through a straw and ate saltines for days while she picked the movies and brought me my medications. I had never touched myself more tenderly than when I washed those wounds for the first time.
My adaptation to this new form has amazed me. There was a period of trying on all of my clothes and discovering new freedoms — I can now shop online, wear bras without underwire or no bra at all, sprint without clutching my chest and wear a fitted T-shirt outside without getting honked at — but six months after my surgery, I already felt accustomed to my changed shape. Now, more than two years later, my wife and I still occasionally joke about my “modest bosom,” but I hardly think of it. I am happy with the physical results, but more notable, I enjoy the absence of that familiar preoccupation. The assumption about cosmetic surgery is that it will give the patient something she didn’t have before, but I’ve found the greater gift to be what it removes. My body’s meaning has consolidated and is less contingent on the perceptions of others.
I had always experienced my body, particularly my breasts, as something I needed to keep hidden or to manage. In the first weeks after my surgery, I couldn’t look at myself in the mirror because the sight of the incisions made me woozy. Instead, I asked my wife to look and tell me what she saw. I stood and opened my shirt. It felt like baring myself to the sun for the first time. How warm it was. How quickly I had stopped treating my body like a terrible secret. It was less the physical alteration that made it possible than the conversation we had in that steamy room and the decision that followed. Naming my experience returned my body to me more conclusively than a scalpel ever could.
Melissa Febos is the author of the recently published book “Body Work: The Radical Power of Personal Narrative” as well as the essay collection “Girlhood,” which won a National Book Critics Circle Award.