When Was The First Boob Job?
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Boobs come in all kinds of shapes, sizes and colours. Some are huge, some are small, some are just a handful, some are lopsided, some are different sizes to each other. And some of them are surgically altered to look better. But what is the history behind the boob job? Who had the first one? And how on earth was this procedure developed?

For today's episode, we're listening back to an old episode on the history of the boob job. I'm joined by Professor Ruth Holliday, author of Beautyscapes, Mapping Cosmetic Surgery Tourism. And later in the episode, I'll be joined by cosmetic surgeon Professor Vikram Devaraj. Let's hoist them up, Betwixters, and crack on!

Professor Ruth Holliday, thank you so much for joining me here today, Betwixt the Sheets. It's so nice to have you here. Oh, thank you. It's really lovely to be here and lovely to meet you. And Ruth Boobs, they are so fascinating, aren't they? And you are a professor of culture and gender and sexuality and you have published widely on cosmetic surgery and

Boobs are such an important part of that, isn't it? They are endlessly fascinating and I have no idea why. Like, why? We're so culturally obsessed with them but when you really break it down and you think about it, they're just boobs, right?

I suppose boobs are a key marker of gender, aren't they? This is true, yes. So I think, you know, that's got a lot to do with it. And, you know, we live in a society where we have very highly differentiated gender. You know, there are plenty of other societies that don't differentiate by gender so much. But in our society, we do. So I guess it's, you know, Freud likes to talk about the phallus as being the phallus.

..differentiator of sex and gender, but I think boobs are equally so, but just not really spoken about in the same way. That's true. And they're, I suppose, a much more visible marker of gender and sex. I mean, you can't really be swinging a phallus around or putting a phallus in a push-up bra. Maybe you can. But boobs, they're just kind of there, aren't they? They're just sort of subtly on show. But, yeah, like, it's become a real marker of...

I suppose, femininity. And has it always been like that? Have we always, there's no denying that now boobs are a real thing in our culture. Has it always been like that? Have we always in the Western culture been obsessed with breasts?

I think breasts go in and out of fashion. So it's in terms of thinking about augmentation or enhancements of various kinds, you know, that's a sort of relatively new thing. I mean, I guess there's sort of people that can tell you the history of sort of fashion and sort of binding breasts so that they're kind of higher and more visible in nice dresses and so on. But I guess that was more of an aristocratic practice.

And what we've got now is a much more sort of democratic space for breasts. I love that. Democratic tits. Tell me what you mean by that. So I suppose now, you know, lots of people, far more people than before, are kind of working on their breasts in various ways. And I think the sort of start of the popularity of that is really in the kind of the turn of the 19th, 20th century.

As early as that? Yeah. Wow. So we get, I mean, well, actually, you know, it's interesting that like in the 1890s, even as far back as the 1890s, you've got the beginnings of breast reduction surgery and breast augmentation through liquid paraffin and so on. Hold up. Whoa, whoa, whoa, whoa. I'm going to need you to go back on that one for a second there. That sounded like you said liquid paraffin. Just for a second there.

It would be wrong to think of the beginnings of breast augmentation being the silicon implant. That's really quite a late developer. And so lots of other kinds of technologies for enhancement before that, ranging from falsies, which you just stuck in your bra. I mean, that was a kind of multimillion pound industry in the US, pre-war US industry.

But, you know, there's all sorts of things. So liquid paraffin injections were kind of started in the 1890s. In the 1920s and 30s, there was what we call autologous fat transfer, where you kind of move fat around from different parts of the body into the breasts to make them bigger. But these tend to go in sort of cycles. So, for instance, in the 1920s, the fashion is...

a very masculine figure for women. Yeah, but when you get to the kind of post-war 1950s, there's like a much more voluptuous look. And so people are sort of trying to get involved in technologies which give them bigger breasts in the 1950s. Then in the 1960s, it's back to small ones again. So you get these kinds of cycles, like on one level.

there's a kind of cycle of fashion, but there are also other really important reasons behind it as well. What do you think? I've never thought about this before, but that is absolutely and perfectly true, isn't it? Is that boobs size do go in and out of fashion. And what would be some key motivators to that? I mean, apart from the fashions that were coming in and out that kind of, I suppose you have to have the kind of boobs to wear it, but was there cultural impact as well behind that driving that?

I mean, you know, fashion is always, you know, it's sort of connected to ideas of kind of progress. It has to be constantly moving. Once everybody is just doing the same thing, it's no longer fashionable. So fashion has to kind of, you know, it has to keep up a cycle. And then sometimes fashion is kind of linked to a sort of zeitgeist.

So in the 1980s, for instance, when there was when we got kind of suits that were with broad shoulder pads and narrow waist and power dressing and so on, you know, that was a time when women's body style kind of emulated men's in many ways. But by the time you get to the 1990s and the noughties, you've got a much more kind of curvy look coming back, which is preferred.

The gendering of bodies kind of moves in and out of fashion, other kinds of things. You know, fashion often sort of accentuates different parts of the body. So cleavage one year and it might be legs the next year and it might be butts the next year after that and so on. I've just never thought if I have fashionable tits or not. And now it's just such a strange concept, but it's been there the whole time, hasn't it? I've got to ask, like these early...

procedures of having paraffin injected into the breasts. Is there any records that survive that tell us the outcome of that? I'm going to guess that it wasn't a roaring success. Yeah, of course, you know. It's really flammable, right? Paraffin, you wouldn't be able to put your boobs near a naked flame. That's one of the outcomes, really. I mean, it's interesting because liquid paraffin was being used for all sorts of things at the very beginning.

used to fill lines, you know, in the same ways we use fillers now, for instance.

But particularly the early examples are kind of in Japan, it was injected into the breasts of prostitutes. So like basically the bigger your breasts, the more money you could earn. And so that was kind of a thing. But paraffin, the problem is with liquid paraffin, it's got a tendency to migrate. That's like the big thing. So you put it somewhere and then later on it moves somewhere else. And of course it irritates the tissue around it. So you get all sorts of lumps and bumps and sores and kind of...

That just sounds dreadful, but okay. The same in a way with the fat transfer is that fat doesn't stay where it's put either and it tends to get absorbed back into the body, can go lumpy and it can migrate. And after a while, both of those procedures, you can end up with becoming very misshapen, for instance.

Oh, and they're doing fat transplants to boobs now. I was reading about that and the kind of the headline for it is it sounds amazing. It's like, right, we'll suck the fat out and we'll make your boobs bigger. And you think, winner. But then like the small print is exactly that. Still that. Like today, it's that it could go lumpy. It could just be reabsorbed. It could...

Yeah, it doesn't sound ideal, that one. I mean, some of the state-of-the-art fat transfer now is done a bit differently. Oh, okay. So we're doing research in South Korea, for instance.

So, you know, the way it's removed now is different. So it's removed in a kind of in a procedure that's very similar to liposuction. And then the fat is removed and then it's kind of put through a centrifugal machine which separates fat cells from stem cells. And they then recombine the fats with a much higher ratio of stem cells.

The advantage of that is that stem cells then grow a blood supply to the fat, which both then anchors it in place and also stops it kind of going necrotic. So the risk is every time you go in and out of the body, you've got a risk of infection. But the incisions are much smaller than these kind of earlier fat transfers when they were taking kind of big lumps of fat from the oar.

for Maral. So, yeah. That is really high tech. I had no idea about that. Now, I read somewhere, and this might be one of the nonsense things that you read on the internet. I read that Marilyn Monroe had breast augmentations. Is that nonsense? Do you know? I've got no idea about that.

I would like to guess but certainly Marilyn Monroe was an inspiration for breast implants yeah in that kind of you know the new look after the second world war what happens is you get this new kind of much curvier look so like Marilyn Monroe Diana Dawes is our kind of British equivalent that kind of really fueled demand for breast augmentations both in the US and the UK as well I can see that one who was

the first person to have breast implants? I mean, apart from, you know, the paraffin and whatever else they were doing, but like what we would recognise now as silicon and less demented than having your boobs pumped full of flammable materials.

So it was Timmy Joan Lindsay. She was the first person to have a breast augmentation using silicone implants. I should kind of note actually just before that, there was a product called Surgicome, which was developed by Robert Alan Franklin in 1953. And that was implanted into somebody called Lindley. That was the pseudonym. But he wrote all about that and documented this procedure in his book.

1963 book which is called Beauty Surgeon but then later on of course then we get Timmy Joan Lindsay first person to get breast implants proper and I think as far as I know she still got hers 50 years later oh wow okay still intact still going strong and they were implanted by Thomas Cronin and Frank Jones

So, you know, again, there was a revival of liquid silicone as well in between the surgical and liquid silicone injections, of course. That was always a bit of an underground practice, not really a respectable medical practice.

- Well, it was quite late on, I think it's 1962 that they actually invented a silicon shell, kind of rubber silicon shell that silicon was put into and then that was implanted underneath the breast tissue. So there were lots and lots of different- - Trial and error. - Yeah, yeah. Breast augmentation before we sort of settled on the silicon breast implants. - I dread to ask what the foam was.

Was it as horrible as I'm imagining it? It's a foam. It was a foam. You know, it was in some ways good because it could be sterilized properly before it was implanted. It was very easy to mold into the right shape. So you could get sort of like a little turn up, you know, that were very fashionable at the time. Problems of that was then breast tissue kind of growing into it because it wasn't porous.

So if you did have any problems, it was practically impossible to remove again. And then, of course, you know, when you've got breast tissue kind of growing into something like that, you get scar tissue, which makes it very hard. Oh, all these poor boobs. So tell me about...

Timmy, what happened? I'm trying to think that even now going for breast augmentation must be quite a daunting process because, you know, you're being cut open, you've been knocked out. Things are being shoved inside your body. I can't imagine what it must have been like in 1963 for her to have said, is there some plastic that you could put in my chest? Like what happened there? Did she know she was having it done? Did she ask for it to be done?

So apparently she went into the clinic and had a tattoo removed. Oh no, oh Timmy. And then I think she was persuaded to, you know, enter a trial in effect, to be a kind of, to trial this new technology of breast implants. And I think she said she'd rather have something done to her ears than

But I think she wanted her, I can't remember if she wanted her ears pinned or some surgery on her ears, but they just persuaded her to have the breast augmentation surgery instead. Wow. And so she did that. And she hasn't, whereas other people around her have brought lawsuits against the company. Dow Corning was the kind of early provider of materials for this company.

And, you know, they have settled very many lawsuits. I didn't know that. Right. OK. So some people did sue because they were experiencing difficulties and symptoms from their implants. But Timmy Jean Lindsay just never did. You know, she said that she's had some problems with her implants, but she's never taken any action. Never taken any action. She's been OK since.

They've not been replaced? No, she still has them and they've not been replaced. Wow, that's fascinating. But it would seem that she kind of almost lucked out there if other people, they didn't do quite so well. I mean, the history of breast augmentation is,

You know, it's a very bumpy history. And I guess, I mean, you know, one of the things that you've probably heard a lot about, for instance, is the PIP breast implants. Yes. Which happened in Europe and particularly, you know, here in the UK, there are sort of 50,000 women with these toxic implants. That's slightly different because the implant was kind of made up of non-medical grade silicone as a way of making them cheaper. So what kind of silicone...

Was it just... Well, it was the same silicone that's used as a mattress filler. Oh, no. Oh, no. Oh, I didn't know that. And the problem with it is, you see, so with a normal silicone breast implant, they talk about it as if it's like a, you know, they say it's like a jelly baby. So you can cut a jelly baby and you can pull it apart, but the thing will still stay in. Yeah. PIP, breast implant scandal, because they used the wrong silicone.

silicone once the breast implant was ruptured and the shell of the pip implants was inclined to rupture then you've just got liquid silicone inside that spills out and it just travels all the way through the body there were women with silicone in their ankles for instance

because it just follows gravity. And, you know, once it's sort of out there and in the body, it's almost impossible to remove. It tends to kind of cling to lymph nodes. Hence, lots of women complained about soreness under their arms and so on. And what would be sort of like soreness where it was landing? But what else would that cause? What kind of symptoms would you experience if you had a silicon leak in your body?

I mean, there are various cancers associated with it. People reported higher levels of miscarriage, tingling in their hands. Oh, my goodness. All sorts of really very difficult. And then, of course, there's the kind of psychological effects of knowing that you've got something toxic, like literally in your body. And so the anxiety that that provokes for lots of people is really high.

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I remember when that happened and I remember it was during a silly time in my life where I was listening to phone-in radio shows with angry people. I shouldn't have done it. But they were talking about that and the subject under discussion was whether or not the women who had had these faulty implants should have them removed on the NHS, if the NHS should pay for them to be removed. And I remember the amount of people who phoned in with this attitude of, like, well, no, because they paid for them, so they should effectively have to pay for it themselves. And it was a really strange attitude to have.

that I remember at the time thinking that's, they wouldn't have said that for any other if it had been like a surgical procedure and something had been left behind or a mistake had been made. So, I mean, you know, don't forget, you know, in the UK, the huge majority of breast augmentation is done in the private sector because the NHS just doesn't provide stuff like that. There's very clear distinctions.

I mean they're often difficult to uphold but distinctions between plastic and cosmetic surgery or reconstructive cosmetic surgery. So most people, you know the huge majority of people have these put in in the private sector. So the private sector argued well okay you know we implanted them but we didn't know they were faulty and therefore the problem is with PIP, with the French company who manufactured them

So, you know, it's not our fault. But even then, you know, I think it's Harley Medical who implanted on 17,000 patients and they just argued, well, there's no way that we can afford to remove those implants anymore.

So they sort of declared themselves bankrupt, transferred their losses to a holding company and then reopened the following day with the same name and phone number. The way that you can avoid these kinds of things in the private sector is quite astounding. That's shocking. I had no idea. I didn't know that that had happened. Yeah, all of the kind of budget clinics.

had been doing a lot of this stuff and you know obviously because they're sort of you know slightly cheaper implants they could kind of make a bigger profit by using these implants so that's a big incentive but for the NHS yes I mean I thought it was really you know that was a kind of woman blaming really it was just you

You know, it's not like if you went skiing or something and broke your leg, they'd go, well, you know, you shouldn't have gone skiing. It's your own fault. Everybody knows that's a dangerous sport. But with breast implants, they were saying, oh, well, we'll remove them, but we won't replace them. That's really hard because, you know, if you...

imagine you've had this implant filling out your breast and then you take it away what happens to your breast after that and you know like lots of the women who had had those because these companies they don't only sell breast augmentations they also sell the finance for it so lots of women were still paying off the finance on their implants they couldn't afford to then get new implants

to replace the faulty ones. It's just such a sad story, that one. And there's so much pain there. And I hope whoever has been horribly affected by this is doing all right and is getting better from it. And I think that you kind of touched on there about something that's really interesting when it comes to breast augmentation is just how accessible it is now. So I remember I'm a child of the 90s and I remember that boob jobs was very much something that celebrities did. Like if you knew someone with a boob job, it was quite an exotic thing.

thing almost like my god now like there are adverts on tv you can get as you said finance and a new trend that i'm seeing is that people going abroad for their surgeries and i don't want to like suggest that anyone doesn't know what they're doing but it's always struck me that one is like is that a good idea to be looking for a deal for a bargain deal when it comes to this stuff

So, okay, so we did a big piece of research on this and we've got this book called, give my book a little book, called Beautyscapes.

which is by myself, Meredith Jones and David Bell. And we sort of did a three year project where we followed patients on their cosmetic surgery tourist journeys from Australia to Thailand and Malaysia and from the UK to places like Tunisia and Poland, but also Spain and other destinations. And we also looked at South Korea, which is a kind of really leading destination. And

And we sort of read all this stuff in the media about, you know, kind of cowboy surgeons abroad selling dodgy surgeries to naive women from the UK and, you know, them having to come back with bad surgery and get patched up on the NHS. But actually what we found was very different. Oh, thank goodness. OK. Well, for one thing, 98% of the people that travelled during the course of our study and we sort of interviewed, I think it was 105 patients in the end.

said that they were happy with their surgery and would recommend their surgeon to a friend. Brilliant. A lot of the cheapness of the surgery was about things like either currency conversions, so the pound against the zloty was very... I see. Yeah.

So it's interesting that, like, for instance, patients from the UK could go to Poland and they would be accessing, you know, top prestigious clinics like sort of Spire clinics, I guess. They could access those, but they'd be paying half the price for surgery in Poland that they would be paying here.

for surgery in the UK, you know, I mean, surgeons have to go through broadly similar training and... Of course, yeah. I'm so relieved to hear you say that. I didn't know because you do hear this narrative a lot, which is, you know, that someone's gone abroad for a Brazilian butler for whatever it is and they were filled with concrete cement and it's all just gone horrendously wrong and all this stuff. But there's a lot more going on there that is slightly xenophobic, would we say?

Yeah, I mean, yeah, there's a kind of our surgeons are better than anybody else. Get your boobs done in blighty. Yeah, well, yeah, absolutely. And of course, you know, there's a certain amount of protectionism because people don't want the business going elsewhere. These are very lucrative industries, you know, so they don't want British surgeons, organisations don't necessarily want patients going abroad elsewhere.

That said, you know, there are some dangers. I think that if anybody ever thinks that they could go somewhere and get liquid silicon injected into them, just don't do it. Don't do that, no. Don't do that because that's just not something that's ever going to work. And it's difficult now because there's a sort of distrust. There's a distrust of governments, of regulation, of medical professionals.

professions. I mean, we've seen this around COVID, like not believing medical information and having back channels. And of course, the same thing goes on now with cosmetic surgery. You know, women can be very suspicious of medical professionals, not surprisingly, because they haven't always been taken very seriously in the past.

And so, you know, there's a sort of, oh, well, you know, it says online here that liquid silicon is perfectly safe. So people can be getting false information online that's going to lead to those sorts of dangerous things. Hmm.

But the people in our study, and I should say people here because 30% of our patients were men, and that's men's surgery is often very underplayed. But, you know, they all did a huge amount of research. They didn't do it in the way in which surgeons would like them to do it in terms of,

evaluating their medical qualifications and memberships but what they did was they really surveyed all the information about they would kind of narrow their choice down to about two or three surgeons and then it's spend a year watching to see if there was any scandals online or anybody complaining or they would join agents facebook groups so that they could watch people going through their procedures in real time and work out that you know if there was any risk

by watching others go through it. So this isn't a spur of the moment, I'll just nip over to Greece and have a nose job type of thing at all? No, most of the patients in our study have been thinking about surgery for about, you know, between five and 10 years, actually. And they had all been researching their surgeons for at least a couple of years.

That is very good to know. I'm very glad to hear that from you. And one of the things that just to change tack, I've always wondered this, are breasts as sexualized in other cultures?

Because you see footage and pictures of various indigenous peoples around the world with just, you know, breasts out. And it's clearly it's absolutely no big deal to them whatsoever. And yet if I tried to pop to Asda with my breasts out, I'd be arrested. That's not from experience. I haven't tried that, but I'm just going to guess.

There used to be this old saying in there that was, you know, if white women's breasts are out, it's pornography. And if black women's breasts are out, it's anthropology. Oh, my God. It's so true. Oh, yes. The kind of colonialism of that. Yes. All those nasty colonial postcards from the 19th century and early 20th. It's pretending to be scientific interest, but it's not. Yeah.

Yes, you know, it's very interesting because for like in Western cultures, bigger breasts are obviously associated with sexuality. So the bigger your breasts, the more sexual you're assumed to be. And, you know, actually, that's a big reason for women having breast reductions, which is a surgery that's actually older than breast augmentation.

And, you know, I mean, for instance, in the UK, we've had a kind of white femininity, middle class femininity that has been very concerned to be desexualized. So small breasts were seen as more respectable. And you're then the person that's marriageable rather than the girlfriend or the mistress who might be more voluptuous. Okay. Yeah.

So this kind of, you know, desexualizing of the body is a sort of way of doing respectability. It's like having bigger breasts, especially and then especially showing them having cleavage, having low cut tops. Those have been seen as both sexual, but also like belonging to working class women or sometimes black women who are seen as more sexual, a bit more animalistic.

than properly, you know, respectable middle-class men. One thing that I think is really happening in Western culture at the moment is that sexualisation is kind of losing its...

it's kind of bad moral status. And so it's almost something that everybody is expecting to perform, you know? So that's one thing, but you know, yeah, there's lots of places in the world where people would just be appalled at the idea of a breast augmentation. And then in South Korea, for instance, in South Korea now, just in the last few years, breast augmentations are becoming a bit more common and

But really for the last sort of 10 or 15 years, it's been about widening your eyes, narrowing your jawbone and augmenting your nose tip. And this is known as the Korean look. Lots of surgical tourists, medical tourists from China travel to Korea to have this set of procedures done.

where the jawbone is shaved, they call it. And yeah, eyes are kind of made bigger to kind of get a cute look that's very popular. Yes. Okay. Yeah. Oh, my goodness. It's fascinating, isn't it? It's like, what is the surgery that people are really going for in different countries? And what does it say about them? And I think that when it comes to boobs, there's a real...

like what is the sweet spot because people who don't have big boobs they want big boobs like give me the silicon i want big boobs and that the people who have got big boobs like you know the tit fairies turned up around puberty and just went ta-da they will almost always just no you don't want them you don't want them they suffocate you when you sleep i can't wear clothes it hurts my back like where's the sweet spot with this i

think the problem is is that different people have different preferences of course so for one thing of course we just mentioned there's a sort of different class preference for breast size and this is often it's very difficult to encounter when women go for breast augmentations they want quite big breasts do you think that's still enforced that there's still a class issue around breast augmentation today

you know, that still thing really it's, you know, just to return to something you were talking about earlier on about used to be film stars and celebrities that were getting breast augmentations. They were sort of quite rare. Well, of course, what that does is it means it's, it kind of makes it quite high status. You know, of course, if you're a film star or a celebrity, you might need a breast augmentation, you know, it's kind of part of investing in your body because your body is how you make your money. Right.

for ordinary people they can kind of get a bit of that glamour by doing things that celebrities do you know I think there's a kind of

People get it wrong when they say, oh, they just want to copy a certain celebrity. It's not that. But if you can sort of say, well, you know, I'm investing in my body just like a celebrity does, that means that you have value. Your body's worth investing in. I've never thought of it like that. That's very true. Now, the problem is if you then have really small breast implants, who's going to know? That's true. Go big or go home, right?

So there's a sort of, and again, I think that kind of varies a bit across class because middle-class women don't need that value as much because, you know, they might be working in parts of the economy where, you know, your brain is seen to be more important than how you look, you know, but that's a kind of privilege in a way. Absolutely. You know, there might be an academic where, you know, if you look like you've actually hedged backwards,

I encounter that all the time in this particular arena is there's not much. Yeah, it's like everyone expects you to look, as you said, dragged through a hedge backwards. And it's fascinating, isn't it? About what we associate with big boobs and the cultural messaging around it. And I could honestly, I could talk to you about tits all day, but I'm going to round it up because I want to save your voice as well. But the final thing that I want to ask you is why?

What's the future for boob augmentation, do you think? Where are we going? What new trends? I mean, the technology is pretty much the same in terms of implants. I suppose it is, isn't it? Could it open, put something in? Yeah. I mean, that's been, you know, there's kind of been slightly different shapes.

different sizes I mean I mean one thing that I sort of didn't mention that I haven't mentioned is like a really key moment for somebody to get breast augmentation is after they've had kids they get pregnant their breasts get bigger they breastfeed maybe they had all the kids they want to have and then their breasts shrink right back down again

and they sort of long to have that back again, to have that kind of slight curviness back again. And so people getting implants for that would be sort of, they wouldn't be having enormous ones, they'd be having sort of modest ones. Perky ones. Yeah, that would make them feel a bit more kind of feminine, right? Yeah. Back to the kind of gendering thing. But, you know, so different people want different kinds of implants for different reasons, right?

You know, there are different shapes, you know, we go from kind of round to teardrop. So there are those kinds of innovations. And yeah, size goes in and out of fashion. And, you know, in the 90s, you kind of get this very, people want very big implants.

sort of now it's you know much smaller maybe so there are those things as well and then you know in a way this what I was talking about earlier this kind of fat transfer but with using stem cells is sort of some of the latest technology for breast augmentation and you know what's good about that is once you've got over the significant risk at the beginning

you don't have much risk going forward because there isn't an implant there. There's still issues to be solved like capsular contractions. So I think sort of somewhere, they won't tell you, but somewhere between 20 and 40% of all breast implants end up going hard because scar tissue builds up around them. And so there's probably gonna be some innovations made there of how to stop that happening.

But I don't know. I think in societies where we want, you know, two opposite genders and key way of marking that is through quite visible presence or absence of breasts. You know, I think breast implants are probably here to stay. I think that they probably are. But as long as they're safe or getting safer and we're not injecting ourselves with

paraffin any more yeah also or liquid silicone oh thank you so much Ruth if people want to find out more about you and your work where can they find you online they could find me at my university website I have a homepage I didn't want to name my university today because we're all looking industrial action because our employers have chopped up

pensions by up to 45% or a guaranteed pension, I should say. And, you know, we're also in dispute over workload and pay and casualization and inequality. So I didn't want to stay where I am. But

if you google me and if someone wanted to find you on twitter or on social media i'm on twitter but i i don't at the moment i'm sort of more tweeting as a member of ucu than i am solidarity strong work i love it thank you so much for talking to me ruth you've been absolutely amazing been great thank you thank you

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So Professor Vikram Devaraj, thank you so much for joining me on Betwixt the Sheets. And I was going to read out a list of all of your qualifications, but you have so many letters and numbers after your name, it looks like a Wi-Fi password. So I'm just going to say that you are the man to talk to about boob jobs. The plastic surgeon extraordinaire. That's very kind. I don't think the letters...

mean anything in particular and in terms of boob jobs I'm one of many people you could talk to and I'm more than happy to I'm happy to share what I know but

I think most of what I do is cancer and trauma. I'm concerned that my colleagues and my mates will say, Devraj, WTF are you going on about? Like you're a Mr. Boob. I'm not Mr. Boob. There's loads of Mr. Boobs. There's loads of Miss Boobs and gender neutral boob suppliers. Other options are available. I am

The most I've taken off last week, I took off two weeks ago, two and a half kilos of breast. I don't think I've got two and a half kilos of breast. Taking 800 grams, 900 grams, a kilo of each breast isn't uncommon. And so many of the patients...

So that's the point. So many of the patients who come in are coming in, say for a breast reduction, because they get backache, neckache, pain, skankiness underneath the boob, because they just can't keep it dry, because you've got fat on top of fat. And it's really difficult. I mean, how you can't exercise. And so they get laughed at because they're not that big. And the reason they're big is because they're trying to stop other people looking at their boobs.

and they can't get bras they have to wear these little giant parachutes on top of them because intense because you just can't buy them and when you change them and you get the silhouette right they come in and their faces and their expressions they're so so happy so you've got that's life-changing isn't it yeah it's the same it's the same it's somebody who's really small and is really uncomfortable and doesn't feel like a woman coming back in and the smile they give you go home and be bigger

is matched by somebody who's got all the symptoms and comes in and just thinks, oh, my breasts are not a feature. They don't come into the room 10 minutes before the rest of me.

I'm so excited to talk to you about this. So the simple question that we're going to go for is, could you explain what a breast enlargement is and what a breast reduction is from a surgical point of view? What's the procedure? Just as the name suggests, one is making the breast larger and the other is making it smaller. Interestingly, both of them seem to have a huge impact on the patient.

So breast enlargement would be usually putting an implant, which is usually silicon based. And the history of how they developed is also really interesting. And that would go either above the muscle, which is the chest wall muscle, the big pec major, the muscle that you use for pulling your arm back, or it would be above.

And that gets left in place in situ. And usually they don't have to be changed unless there's a particular problem with the implant. And we can talk about that separately. In terms of a reduction, the idea is to reduce the breast, keep it as shapely as rounded and has a nicer silhouette as possible.

thinking about the scars, thinking about nipple sensation and thinking about the blood supply. Okay, so if you were going to make them bigger, what's the difference between being above the muscle and under the muscle? Why the difference?

It's a good question. It all depends on the shape and the size of the patient. So if you've got enough breast parenchyma, by that we mean actual native breast tissue and a reasonable amount of subcutaneous fat, then you can put the implant behind the actual skin. So behind the breast tissue itself.

But if, for example, you're really super skinny, you're a smoker, your BMI is very low, you've had some children, you've lost quite a lot of breast tissue after breastfeeding. If you put it underneath the skin and behind the breast itself, then you may see an outline of the breast. The shape may be abnormal. You might have rippling or wrinkling or knuckles. So if you put it underneath the muscle,

then wherever the muscle can cover it, and it can't cover all of it, it will disguise the kind of edges and the shape and sometimes can look more natural. Ah, okay. So it's not really that one is better or worse. It's dependent on the patient. Absolutely. And something that I read about recently that I hadn't heard of this before, but breast enlargement by fat transfer. Tell me about that. That sounds crazy.

So some people have concerns and anxieties about having anything foreign implanted into them, or they may have had problems with breast implants in the past. And one of the issues is something called a capsule, which forms a very tight membrane. So your boob almost feels like hard, can feel hard, almost be shaped a bit like a coconut.

And in that case... Well, that's not nice. No one wants that. Nobody wants that. So in that case, if you either have a concern about having something implanted into you or you have a complication, then using your own body fat, it sounds like a great idea. But the first thing is that one, you have to have enough fat. Not a problem. Not a problem.

And you have to have it uptake the way too. You have to suck it out and then you have to put it back and it doesn't always stay where you put it. Sometimes it gets absorbed. Sometimes it gets, it can form firm little lumps or nobbles and it doesn't necessarily always look

as nice as Shape Blue is attractive. If it did, then it would be great because all of us would be doing it. Yeah, when I first read about it, I was like, everyone must be doing that. I can make my belly smaller and my boobs bigger. Why isn't everyone... Okay, but it gets reabsorbed and it can... Right, okay. You're right. It sounds like a win-win situation, but the indications for it are you have to be really careful in your patient selection. All right, but I will keep cultivating my belly just in case the procedure's perfected. Well,

Where that's really good to have abdominal fat is for breast reconstruction. So you can make a boob, an autologous reconstruction, particularly after cancer, after mastectomy, after... So don't forget that the implants that we're talking about are exactly the same implants that would be used after breast cancer. And one in nine women will get breast cancer, of which some might have a local bit of breast cancer tissue, depending on the tumour, taken away.

with a wide local excision and maybe radiotherapy, but others might need a whole mastectomy. And if you're having a whole mastectomy, then using an implant is one way, but you could use your tummy fat and you could take your tummy fat not by sucking it out with a hoover,

but with actually taking a block of tissue out with its blood supply attached and replugging the blood supply to another part of your chest wall. That's incredible. So that that's being nourished and fed and is healthy and feels like your tummy fat. So that tummy fat and skin, by being kept alive as a block, it's called a free tissue transfer and has been around for a long time, for decades, and it's been refined and refined as we've gone on to use smaller vessels, is really cool. That is...

That is. The only downside, there are several downsides, but one of the downsides, of course, is that you can't necessarily feel that skin and fat. So you don't want to go sunbathing.

and get sunburn and a burn on your boob. And you wouldn't know. Because you wouldn't feel it. And if you put weight on, it will put weight on your boob too because it's abdominal fat and it behaves differently to the fat on your boob. So it just goes rogue and you could have one overweight boob? That doesn't sound right at all. In theory, yeah, you can, for sure. Because the cells are from a different location, so they'll behave differently, for sure.

I didn't know that. So when it comes to sort of the more traditional, like it's an implant, what is the implant made of? Because I do remember there was a few years ago when it was all coming out that someone had used industrial silicon instead of medical silicon. So what is the implant made of? Yeah, I think you're talking about the PIP, the PIP implants. That's the one. So it

Implants are essentially made of silicon, medical grade silicon. And I think the first implant was all sorts of things have been used in the past, including paraffin wax, beeswax, injections. I think some use ivory, amber, all sorts of things. I think the first ever implant was in the 17th century, 18th century, where

1895 it was, I think, where somebody took a lump of fat that they'd grown in their back and the surgeon moved it to the front. It was a lipoma, which is a benign fatty growth. And because they'd taken away something from the breast, he recognised there was some fat at the back and moved that. It was 1895. That is awesome. That is awesome. Do we have any records of how that patient coped?

afterwards? Well, they must have coped pretty well because it's such that it was A, reported and B, it's memorised and quoted. But we, silicon is medical grade and in fact the first commercial implants, if you like, were in the 1960s.

And one of the two American, the Texas surgeons who developed it had the idea, I think it was Frank Garrow, where he felt a blood bag, a bag of blood in his hand. He squeezed it and he thought, this feels like a boob. I wonder. As you do.

as you do. And from that, they were the first people in the 1960s who, in fact, they used a dog called Esmeralda. No, they didn't. I don't know what sort of dog it was. They put tits on a dog. I hope this doesn't offend anyone. They actually trialled, it was only, many things are often trialled on other mammalian species in medicine. And the dog, I think, coked with the bag for a bit and then probably started to chew it out. But it's

Maybe that's going to the gruesome side, but history is gruesome. It's always gruesome. It's very gruesome. They put...

breast implants on a dog called Esmeralda? I think they used a bag. I don't think they put two. I think they were trialling to see if you could implant something subcutaneously to see if there was a reaction, if there was an infection, how the tissues coped. And because it was relatively inert until the dog started... I mean, dogs will nibble unless you put a big collar or a crown or a cone round them. That's what they do. Oh, I think we've just discovered a whole new category at Crufts.

Dogs with breasts. No, OK, I'm going to get stuck on that. The woman who had the first breast implants, her name was Timmy, was it? Is that right? Yeah? Yeah, it was. I think she'd had about six children and she was in Texas. And I think she went to see them about something else. And they just said, while you're here, do you fancy this? We've done this thing to a dog. Do you fancy it again? I'm not sure they mentioned Esmeralda, but...

But you're right, you're absolutely right. And do we know how she is? Did they last? Only from what I've read. And the reports are that she was really pleased and she went from a B to a C cup and was pretty chuffed.

Oh, that's amazing. And have you noticed the trend in breast augmentation changing? I mean, it's kind of like you think that if you're just going to go big, you're going to go big. But then thinking about it, there are the big melon shape that Pamela Anderson pioneered in the 90s. That's not very trendy now, is it? Have you noticed there are shifts in taste when it comes to how people want their breasts augmented?

With any society, shifts change all the time. Things go in circles and they go up and down and vacillate. With any form of aesthetic, surgical, cosmetic change, I mean, even with breast reconstruction, which is what we talked about as well, there will be influences and trends. And yes, you're absolutely right. There was a trend in the 60s for

and 70s with the Baywatch Babe look. There were certain celebrities, I guess you mentioned Pamela Anderson, before that Marilyn Monroe, Jane Russell. Various influences come and then the whole thing sweeps the other way and people go

and think, actually, these are enormous. They're really uncomfortable. They look unsightly. And then we change and we go back to a more natural look. The most important thing is to, for the right patient at the right time, the right procedure makes the difference. And in terms of the consult, I always start with what look are you looking for and trying to get a feel for what that individual patient might want. The problem, problem,

The situation is, I think we've had programs that have highlighted the fact that we're all different. And that's really important. You only have to watch things like Naked Attraction or Embarrassing Bodies or Botched or X on the Beach or whatever we've got. And it becomes Love Island. It seems to become a massive feature. It's the same with the lip thing. And we've got people who've got lips that look like...

like baboons bottoms what is the point it's just it's not what I want you've got to decide what somebody else wants and at some point someone's going to say this is ridiculous enough's enough and as a surgeon if somebody comes to you and they've already got like let's say massive breast implants and they want to go even bigger and it's not that it would be dangerous but it's that you don't think that it

this isn't a good thing for them to be doing do you say no or are you kind of like if they want it and they're safe I'll provide the service like where are you with that do you say no to people if I was not to say no to people then I don't think I'd be a very good doctor

I think you have to say no at the right time. And you have to be honest and you have to be true and you have to be authentic and you have to care. And as most of them, I would say my colleagues in the profession, that the way to actually nurture and foster and engender a good relationship with anybody in your patients is to be honest. And if someone comes to me and says they want it to have enormous bosoms like melons and they're four foot 11, and I think they're going to look like Jessica Rabbit or what

I should say, I'm really sorry. I think this is insane. It's crazy. Go away. I can't help you. That's good. No, I'm not going to do this for you. Because I read more and more about people nipping over to Turkey or Croatia or wherever for cheap surgery. And it's not that I want to judge anyone for doing that, but I can't help thinking surgery isn't something you should be looking for a bargain basement. It's not something you should get done on the cheap.

It's not something you can shop for. BAPRAS, which is our British Association of Plastic Reconstructors and Aesthetic Surgeons, BAPS, I'm sorry, the name sounds a bit dodgy. Do they not pronounce it BAPS? This always comes up. It's the British Association of Aesthetic Plastic Surgeons. But BAPS, yeah, kind of apposite. They haul this...

organizations just say the importance of the consultation, thinking about what to change and doing it. It's not like buying something online. It's not like going to Amazon and then saying, oh, I don't like this operation that I've had done to my nose or my head, whatever, or my eyes, and take it back. You can't go back and sell it. It's a massive, massive, it is not a nip and tuck, which is kind of often the populist image.

But that's why regulation is so important. And that's why regulation has often been quite slow coming forward. And we're just talking about surgical stuff. There's also the non-surgical stuff. And we don't often know who's doing it, where, when and how, let alone what qualifications they've got. And the public doesn't know. That's what one of the concerns is.

It is quite scary, isn't it, that anyone wielding a syringe could be administering Botox? That's quite terrifying. I find it scary, I agree with you. Yeah. When it comes to breast implants or reduction, what are the risks? Because I think as well it's become quite normal in our culture. All the shows that you mentioned there, there's endless TV shows and they're more accessible and you can get breast implants on credit now. And I think that we kind of forget, like you say, that it's not...

like going to get your hair done at all. So what are the risks that you would make people aware of? The two. So whether it's a breast reduction, making it smaller, a breast lift, lifting them up after they've dropped a bit. Oh, hello. Right. I didn't know you could get that. You can if you need it. Boobs go south. Many things go south. Things with blokes go south. And that's all part of life. And so if you want them to go back up north again, then...

then one way to do it, depending on how far they've gone, is to put an implant in because it will lift it up and you can use different shapes, round ones or teardrop shape and so on. Or you can hoik everything up too. And sometimes you have some people who are born where one or develop where one boob grows and the other one doesn't. So they have breast asymmetry. And so there's so many different reasons that we might do that. But the risks will all depend on what operation you're doing.

So if you're putting an implant in, we'll talk to them about specific risks associated with implant longevity. People will say the same things. When do I have to replace them? How long will they last? What happens if something goes wrong? Do they cause breast cancer? Can I still be screened?

for breast cancer, if I have implants in, can I breastfeed? What will my scars be like? Will my nipple sensation change? And then we have to talk to them about other things like the hardening that we mentioned. And there's a weird thing that, weird is rare, but it's something important. And it's a watch this space problem. And it's called BIAALCL, which is breast implant associated anaplastic large cell lymphoma.

which sounds really scary. So that's something, again, that we have to think about. We think about the biofilm, which is, so anytime you put something in, organisms can land on the surface as they go through your body. And if they do that and they can stay there for a long time, they can produce a biofilm. That micro biofilm then can lead to chronic inflammation. That can cause problems. There's this whole play

plethora of things and the point about this discussion is that I think that you have to do it in stages and you have to do it repeatedly and give the patient the information and you have to give them that information also so they can take home and read and come back to you. In other words, you're absolutely right, it's not popping into Sainsbury's or Lidl's or Waitrose and then checking out at the checkout with a ka-ching, ka-ching, job done. It's bonkers.

Yeah, absolutely. One question before I let you go to save the breasts of the nation. I have always wondered if there is a procedure that is it doesn't necessarily make your boobs massively bigger, but it just kind of perks them up a little bit. And I'm asking this for a friend.

who is me. So I'm 40 years old, I quite like my boobs but they could do with being upwards a bit and I don't really want to go for a full breast lift because that seems quite scary. What's out there? Are there new treatments that you can do for boobs? There are suggestions

things that tighten the skin might be feasible. And they come under different names like intense pulse light therapy and mesotherapy. They're ways of, and at the moment, the number, we look for evidence in medicine.

And in order to be able to say something is reliable, plausible, reproducible, it has to be evidence based. And we don't really have that. But people are trying and doing all sorts of things, stimulating the skin and scarifying it or shining lights on it to try and tighten it. It all depends on the patient, their physical characteristics and what their expectations are. And medicine and surgery is all about matching them.

I'm just not going to get my boobs blazered. That's absolutely fine. I'm just going to leave them where they are. I'm going to, what was it? You called it right at the beginning, native breasts. I like that. I'm going to embrace my native breasts and that'll do me. But thank you so much for talking to me today. It's been so lovely to speak to you. Thank you. It's a pleasure. And to you too. Thanks, Kate.

The breast is a sweat gland. The breast is a modified sweat gland. It's not sexy. It's not sexy that. I know it doesn't sound sexy, doesn't it? If you said, have a look at my sweat glands and it did that, no, you just, it's all going to go horribly wrong. But it is, it's a modified sweat gland that starts life and then the nipples invaginated. And that's why I've got Milkline, because you can get people with extra nipples and extra breasts going right the way, the top, down their armpit, down to the groin.

And then as it forms and it develops, sometimes the ducts don't form, sometimes bits of it don't develop. All sorts of congenital anomalies happen. And then when you take them out, when you actually cut the stuff out, you've got either fat or breast tissue, and we've all got different amounts.

And that's why some people can lose weight and it comes off the boob. And then other people can lose as much weight as they want and their breasts still stay very, very large. Because it all depends how much fat you've got to how much milk-producing tissue. And we're all different. That's amazing. To answer your question, Sophie, it just feels, it's just like, it's fat and ducts and gooey bits that come out. Because when you squeeze a boob, sometimes people can produce all sorts of lovely secretions.

which I actually find quite attractive, but some other people don't because they're often green and the organisms are in there are harmless because they're part of you, they're part of me, they're part of all of us. But, and sometimes you have that, it's called ductectasia. And so when you take that away, it just feels just the same. And of course it floats as opposed to sugar, which will sink because it's fat, it's water, basically water. A boob has never sounded less sexy.

And that's good. I think that's good. We've got International Women's Day and it's got some relevance and some resonance. It's tissue. It's just tissue that floats. It's tissue. It's tissue that floats. Exactly.

Thank you for listening and thank you to both Professors Ruth and Vikram for joining me. And if you like what you heard, please don't forget to like, review and follow along wherever it is that you get your podcasts. If you'd like us to explore a subject or maybe you just fancied saying hi, then you can email us at betwixt at historyhit.com. Coming up, we have episodes on medieval sex myths and the history of the gym all coming your way.

This podcast was edited by Stuart Beckwith and produced by Sophie Gee. The senior producer was Charlotte Long. Join me again betwixt the sheets of the history of sex scandal in society, a podcast by History Hit. This podcast contains music from Epidemic Sound.

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