When Was The First Boob Job?

Cosmetic procedures are a huge part of (most of our) worlds. With new ones seemingly cropping up all the time, the boob job feels like an old classic. What are the origins of the boob job? Who had the first ever one? And how has it changed over time? Today we're revisiting a conversation Kate had with Professor Ruth Holliday and cosmetic surgeon Professor Vikram Devaraj, to find out more about this bumpy history. This episode was edited by Annie Coloe & Tom Delargy. The producer was Sophie Gee. The senior producer was Charlotte Long. All music from Epidemic Sounds/All3 Media. Sign up to History Hit for hundreds of hours of original documentaries, with a new release every week and ad-free podcasts. Sign up at https://www.historyhit.com/subscribe. You can take part in our listener surveyhere https://www.surveymonkey.co.uk/r/6FFT7MK. Betwixt the Sheets: History of Sex, Scandal & Society is a History Hit podcast. Voting is now open for the Listener's Choice Award at this year's Podcast Awards! UK & Ireland listeners please place your vote on the Spotify mobile app here: https://open.spotify.com/s/xhg6PJa Hosted on Acast. See acast.com/privacy https://acast.com/privacy for more information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Kate Lister?

  Do you want even more shocking and scandalous history? Like why the ancient Greek statues had such small manhoods? Or what went on behind closed doors in the Georgian era? Well, sign up to History Hit, where you can see me discover the scandalous side of history, as well as hundreds of hours of original documentaries, plus new releases every week, covering everything from prehistoric Scotland to the Treaty of Versailles. Sign up to join me in locations around the world and explore the past. Just visit historyhit.com/subscribe.

• 0:39Speaker 01

  Whoever said good things come to those who wait, never shopped Black Friday early at Lowe's. Right now, get up to 50% off select major appliances. Plus, get free delivery, free haulaway, and free basic installation and parts when you spend $896 or more on select major appliances. Shop Black Friday early in-store and online now at Lowe's. Valid through 12/2, while supplies last. Selection varies by location. See associate on lowe's.com for details.

• 1:08Speaker 02

  Hi folks, this is Mark Bittman from the podcast Food with Mark Bittman, and I'm here to suggest that you host Thanksgiving with industry-leading quality standards from Whole Foods Market. There are, as usual, no antibiotics ever in their meat department, so carve up turkey and spiral-cut ham with peace of mind. Shop organic sides like stuffing mix and cranberry sauce from 365 Brand. And guess what? All of their fabulous, delectable pies are made with no high-fructose corn syrup. Where else are you going to find that? Gourmet Thanksgiving flavors with the quality you want, only at Whole Foods Market.

• 1:49Speaker 03

  Hey, it's Hannah Burner from Giggly Squad, and the holidays are around the corner, which means I'm officially entering my hostess Hannah era with Arm & Hammer Hardball Cat Litter. You guys know I love cats and fostering, but when I'm hosting, I do not want my house smelling like cats. I want people focusing on my hosting skills. That's why I love Arm & Hammer Hardball Cat Litter. It delivers long-lasting odor control and forms compact clumps that make cleanup easy, so that's one less thing I need to worry about when people come over. Be guest-ready with Arm & Hammer Cat Litter. Find it now at Walmart or Amazon.

• 2:23Kate Lister?

  Hello my lovely Betwixters, it's me Kate Lister. This is Betwix the Sheets and we are thrilled that you are able to join us once more. But before we can keep going with this, I have to tell you, this is an adult podcast spoken by adults to other adults about adulty things in an adulty way, covering a range of adult subjects, and you should be an adult too. We call this the Fair Do's Warning, because after you've heard it, if you keep listening and you happen to get offended, Fair Do's, we did let you know.

• 2:51Speaker 04

  What do you look for in a man? Oh, money, of course. You're supposed to rise when an adult speaks to you.

• 2:56Kate Lister?

  I make perfect copies of whatever my boss needs by just turning him up and pushing the button.

• 3:08Speaker 04

  Yes, social courtesy does make a difference. Goodness, I'm beautiful then. Goodness has nothing to do with that, Derek.

• 3:19Kate Lister?

  Hello and welcome back to Betwix the Sheets, the history of sex scandal in society, with me, Kate Lister. 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 am joined by Professor Ruth Holliday, author of Beautyscape's Mapping Cosmetic Surgery Tourism, and later in the episode, I'll be joined by cosmetic surgeon Professor Vikram Deveraj.

• 4:03Kate Lister?

  Let's hoist them up, Betwixters, and crack on.

• 4:11Kate Lister?

  Professor Ruth Holliday, thank you so much for joining me here today, Betwix 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?

• 4:53Speaker 05

  I suppose boobs are a key marker of gender, aren't they?

• 4:58Kate Lister?

  This is true, yes.

• 5:00Speaker 05

  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 differentiator of sex and gender, but I think boobs are equally so, but just not really spoken about in the same way.

• 5:30Kate Lister?

  That's true. And 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?

• 6:06Speaker 05

  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 finding breasts, though 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.

• 6:40Kate Lister?

  I love that, democratic tits. That's, I love, tell me what you mean by that.

• 6:47Speaker 05

  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.

• 7:03Kate Lister?

  As early as that?

• 7:04Speaker 05

  Yeah.

• 7:05Kate Lister?

  Wow.

• 7:06Speaker 05

  So we get, I mean, well, actually, you know, it's interesting that like in the eighteen nineties, even as far back as the eighteen nineties, you've got the beginnings of breast reduction surgery and breast augmentation through liquid paraffin and so on.

• 7:20Kate Lister?

  Hold up, whoa, whoa, whoa, whoa. Ah, I'm gonna need you to go back on that one for a second there. That sounded like you said liquid paraffin. Just, just for a second there.

• 7:31Speaker 05

  It would be wrong to think of the beginnings of breast augmentation being the silicon implants. That's really quite a late developer. And so there are 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. But, you know, there's all sorts of things. So liquid paraffin injections were kind of, it started in the eighteen nineties. In the nineteen twenties and thirties, there was what we call autologous fat transfer, where you kind of move fat around from different parts of the body into the breasts that's made them bigger. But these tend to go in sort of cycles.

• 8:14Speaker 05

  So for instance, in the nineteen twenties, the fashion is a very masculine figure for women. Yeah, but when, when you get to the kind of post-war nineteen fifties, 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 nineteen fifties. Then in the nineteen sixties, it's back to small ones again. So you get these kinds of cycle, like on one level, there's a kind of cycle of fashion. But there are also other really important reasons behind it as well.

• 8:48Kate Lister?

  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 had to have the kind of boobs to wear it. But was there cultural impact as well behind that driving that?

• 9:08Speaker 05

  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's kind of linked to a sort of zeitgeist. So in the nineteen eighties, 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.

• 9:46Speaker 05

  But by the time you get to the nineteen nineties and the noughties, you've got a much more kind of curvy look coming back, which is the third. 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.

• 10:08Kate Lister?

  But I just never thought if I have fashionable tits or not. And now, that'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 gonna guess that it wasn't a roaring success.

• 10:31Speaker 05

  Yeah, of course, you know.

• 10:33Kate Lister?

  It's really flammable, right, paraffin? That's, you wouldn't be able to put your boobs near a naked flame.

• 10:38Speaker 05

  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.

• 11:21Kate Lister?

  That just sounds dreadful, but okay.

• 11:24Speaker 05

  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, it 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.

• 11:41Kate Lister?

  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.

• 12:04Speaker 05

  I mean, some of the state of the art fat transfer now is done a bit differently. So

• 12:09Kate Lister?

  Oh, okay.

• 12:10Speaker 05

  We're doing research in South Korea, for instance. So, you know, the way it's removed now is different. So it's removed and they're kind of, and the procedure is 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 fat 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.

• 12:49Kate Lister?

  Yeah.

• 12:50Speaker 05

  But the incisions are much smaller than these kind of earlier fat transfers when they were taking kind of big lumps of fat.

• 12:56Kate Lister?

  Oh, oh.

• 12:58Speaker 05

  From where else. So, yeah.

• 13:00Kate Lister?

  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?

• 13:12Speaker 05

  I've got no idea about that. I would like to guess. But certainly Marilyn Monroe was an inspiration for breast implants.

• 13:22Kate Lister?

  Yeah.

• 13:22Speaker 05

  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 Dors, this kind of British equivalent, that kind of really fuelled demand for breast augmentations, both in the US and the UK as well.

• 13:41Kate Lister?

  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.

• 13:58Speaker 05

  So it was Timmy Joan Lindsay. She was the first person to have a breast augmentation using silicon implant. We should kind of note, actually, just before that, there was a product called Surgifone, which was developed by Robert Allen Franklin in nineteen fifty-three, and that was implanted in somebody called Lyndley, that was the pseudonym. But he wrote all about that and documented this procedure in his nineteen sixty-three 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's still got hers fifty years later.

• 14:42Kate Lister?

  Oh, wow, okay.

• 14:44Speaker 05

  Still intact, so.

• 14:45Kate Lister?

  Still going strong.

• 14:46Speaker 05

  And they were implanted by Thomas Cronin and Frank Jarrow. So, you know, again, there was a revival of liquid silicon as well in between the Surgifone and liquid silicon injections, of course. But that was always a bit of an underground practice, not really a respectable medical practice. And it was quite late on, I think it's nineteen sixty-two, 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, lots of different.

• 15:21Kate Lister?

  Trial and error, ooh.

• 15:22Speaker 05

  Yeah, yeah, breast augmentation before we sort of settled on the silicon breast implants.

• 15:28Kate Lister?

  I dread to ask what the foam was. Was it as horrible as I'm imagining it? It's a foam.

• 15:35Speaker 05

  It was a foam. You know, it was, in some, it was good because it could be sterilised properly before it was implanted. It was very easy to mould into the right shape. So you could get sort of like a little turn up. It's a, you know, that were very fashionable at the time. Problems of that was then breast tissue kind of growing into it because it was all 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.

• 16:11Kate Lister?

  All these poor boobs. So tell me about Timmy, what happened? I'm trying to think that, because even now going for breast augmentation must be quite a daunting process, because you know, you're being cut open, you're being 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?

• 16:38Speaker 05

  So apparently she went into the clinic and had a tattoo removed.

• 16:43Kate Lister?

  Oh, no. Oh, Timmy.

• 16:45Speaker 05

  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. 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.

• 17:10Kate Lister?

  Wow.

• 17:11Speaker 05

  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. And, you know, they have settled very many lawsuits.

• 17:26Kate Lister?

  I didn't know that, right. Okay.

• 17:29Speaker 05

  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 about.

• 17:44Kate Lister?

  Never taken them back. She's all been okay. They've not been replaced.

• 17:48Speaker 05

  No, they've not been, she still has them and they've not been replaced. Yeah.

• 17:53Kate Lister?

  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.

• 18:02Speaker 05

  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 P I P breast implants.

• 18:15Kate Lister?

  Yes.

• 18:16Speaker 05

  Which happened in Europe and particularly, you know, here in the UK, there were sort of fifty thousand women with these.

• 18:24Speaker 05

  And that's slightly different because the implant was kind of made up of non-medical grade silicon as a way of making them cheaper.

• 18:33Kate Lister?

  So what kind of silicon was it just?

• 18:36Speaker 05

  Well, it was the same silicon that's used as a mattress filler.

• 18:40Kate Lister?

  Oh, no. Oh, no. Oh, I didn't know that.

• 18:44Speaker 05

  And the problem with it is, you see, so with a normal silicon 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.

• 18:59Kate Lister?

  Yeah.

• 19:00Speaker 05

  P I P breast implant scandal because they used the wrong silicon. Once the breast implant was ruptured and the shell of the P I P implants was inclined to rupture. Then you've just got liquid silicon inside that spills out and it just travels all the way through the body. There were women with silicon 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.

• 19:40Kate Lister?

  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?

• 19:49Speaker 05

  I mean, there were various cancers associated with it. People reported higher levels of miscarriage. Tingling in their hands.

• 20:00Kate Lister?

  Oh, my goodness.

• 20:00Speaker 05

  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.

• 20:24Kate Lister?

  Autumn is underway at last, which means the nights are closing in and everything in nature feels like it's just slowing down, except us, of course. For most of us, me included, the world still has a lot of demands on us that can feel like a lot to deal with. There will be a time in all of our lives when we could use therapy, but often when you try to do that, it's still way harder than it should be. Finding a therapist is hard enough, but finding one who actually takes your insurance? That's where most online therapy platforms fall short. Many don't work with insurance at all, which means you're stuck paying the full cost out of pocket or paying for an expensive monthly subscription.

• 21:08Kate Lister?

  Rula does things differently. They partner with over 100 insurance plans, making the average co-pay just $15 per session. That's real therapy from licensed professionals at a price that actually makes sense. Thousands of people are already using Rula to get affordable, high-quality therapy that's actually covered by insurance. Visit rula.com/shets to get started. That's R-U-L-A dot com forward slash S-H-E-E-T-S, Sheets. You deserve mental health care that works with you, not against your budget.

• 22:17Speaker 02

  Hi folks, this is Mark Bittman from the podcast Food with Mark Bittman, and I'm here to suggest that you host Thanksgiving with industry-leading quality standards from Whole Foods Market. There are, as usual, no antibiotics ever in their meat department, so carve up turkey and spiral cut ham with peace of mind. Shop organic sides like stuffing mix and cranberry sauce from 365 Brand. And guess what? All of their fabulous delectable pies are made with no high-fructose corn syrup. Where else are you going to find that? Gourmet Thanksgiving flavors with the quality you want, only at Whole Foods Market.

• 22:58Speaker 03

  Hey, it's Hannah Berner from Giggly Squad, and the holidays are around the corner, which means I'm officially entering my Hostess Hannah era with Arm & Hammer Hardball Cat Litter. You guys know I love cats and fostering, but when I'm hosting, I do not want my house smelling like cats. I want people focusing on my hosting skills. That's why I love Arm & Hammer Hardball Cat Litter. It delivers long-lasting odor control and forms compact clumps that make cleanup easy, so that's one less thing I need to worry about when people come over. Be guest-ready with Arm & Hammer Cat Litter. Find it now at Walmart or Amazon.

• 23:42Kate Lister?

  I remember when that happened, and I remembered 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 at the time 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 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."

• 24:18Speaker 05

  So, I mean, you know, don't forget, you know, in the UK, the huge majority of breast augmentations 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 P I P, with the French company who manufactured them. So, you know, it's not our fault. But even then, you know,

• 25:03Speaker 05

  I think it's Harley Medical who implanted on seventeen thousand patients. And they just argued, well, there's no way that we can afford to remove those implants. 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.

• 25:30Kate Lister?

  That's shocking. I had no idea. I had, I didn't know that that had happened.

• 25:33Speaker 05

  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, there's the 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 know, it's not like if you went skiing or something and broke your leg, they 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 breasts

• 26:18Speaker 05

  and then you take it away, what happens to your breasts 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

• 26:32Kate Lister?

  Oh.

• 26:33Speaker 05

  The finance on their implants. They couldn't afford to then get new implants to replace the faulty ones.

• 26:39Kate Lister?

  That it that 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 nineties and I remember that boob jobs were very much something that celebrities did. Like if you knew someone with a boob job, it was quite an exotic 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 wanna like suggest that that anyone doesn't know what they're doing, but it's always struck me that one is like, is that a good idea?

• 27:24Kate Lister?

  To be looking for a deal, for a bargain deal when it comes to this stuff.

• 27:30Speaker 05

  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 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.

• 28:15Speaker 05

  And, you know, them having to combat with bad surgery and get patched up on the NHS. But actually, what we found was very different.

• 28:23Kate Lister?

  Oh, thank goodness. Okay.

• 28:24Speaker 05

  Well, for one thing, ninety eight percent of the people that travelled during the course of our study, and we sort of interviewed, I think it's a hundred and five patients in the end, said that they were happy with their surgery and would recommend their surgeon to a friend.

• 28:38Kate Lister?

  Brilliant.

• 28:39Speaker 05

  A lot of the cheapness of the surgery was about things like either currency conversions. So the pound against the zloty was very.

• 28:50Speaker 05

  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 spy clinics, I guess.

• 29:01Kate Lister?

  Yeah.

• 29:01Speaker 05

  They they could access those, but they'd be paying half the price for surgery in Poland that they would be paying for surgery in the UK, you know, I mean surgeons have to go through broadly similar training and.

• 29:16Kate Lister?

  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 they've someone's gone abroad for a Brazilian butthole or whatever it is, and it's they were filled with concrete cement and it's all just gone horrendously wrong and and all this stuff. But that's, there's a lot more going on there. That is slightly xenophobic, would we say?

• 29:39Speaker 05

  Yeah, I mean, uh, yeah, that's a kind of art surgeons are better than anybody else.

• 29:43Kate Lister?

  Get your boobs done in Blighty, that.

• 29:46Speaker 05

  Uh, yeah, well, yeah, absolutely. And of course, you know, there's a certain amount of protectionism because it's 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. 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.

• 30:17Kate Lister?

  Don't do that, no.

• 30:18Speaker 05

  Don't do that because that's just not something that's ever going to work. And it it's difficult now because there's a sort of distrust, there's a distrust of governments, of regulation, of medical 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.

• 31:03Speaker 05

  But the people in our study, and I should say people here because thirty percent 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, 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.

• 31:46Speaker 05

  And work out that, you know, if there was any risk by watching others go through it.

• 31:51Kate Lister?

  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?

• 31:56Speaker 05

  No, most of the patients in our study have been thinking about surgery for about, you know, between five and ten years, actually. And they had all been researching their surgeons for at least a couple of years.

• 32:11Kate Lister?

  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 sexualised in other cultures? Because you, you see sort of like footage and pictures of various indigenous peoples around the world would 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, I'm just gonna guess.

• 32:43Speaker 05

  There used to be this old saying from 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.

• 32:52Kate Lister?

  Oh my god, it's so true. Oh, yes.

• 32:55Speaker 05

  What kind of colonialism of that?

• 32:57Kate Lister?

  Yes, all those nasty colonial postcards from the nineteenth century and early twentieth, where it's pretending to be scientific interest, but it's, it's not.

• 33:07Speaker 05

  Yes, you know, it's very interesting because for like in western cultures, bigger breasts are obviously associated with sexuality. The bigger that 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 de-sexualized. So small breasts were seen as more respectable. And you're then the person that's marriageable rather than the girlfriend or the mistress,

• 33:50Speaker 05

  who might be more voluptuous, okay? So this kind of, you know, de-sexualizing of the body is a sort of way of doing respectability. Whereas 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 to black women, who it seems more sexual. A bit more animalistic than properly, you know, respectable, middle-class women. One thing that I think is really happening in western culture at the moment is that sexualization is kind of losing its kind of bad moral status.

• 34:34Speaker 05

  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. But really, for the last sort of ten or fifteen years, it's been about what, you know, widening your eyes, narrowing your jawbone and augmenting your nose tip. And this is in Korea, this is known as the Korean look.

• 35:15Speaker 05

  Lots of surgical tourists, medical tourists from China travel to Korea to have this set of procedures, whether jawbone is shaved, they call it. And yeah, eyes are kind of made bigger, um, to kind of get a cute look that's very popular.

• 35:34Kate Lister?

  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 silicone, 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 go, 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?

• 36:11Speaker 05

  I think that the problem is, is that different people have different preferences.

• 36:16Kate Lister?

  Of course.

• 36:16Speaker 05

  So for one thing, of course, we just mentioned, there's a sort of different class preference for breast size. And this is often this very difficult encounter when women go for breast augmentations. They want quite big breasts.

• 36:30Kate Lister?

  Do you think that's still enforced? That there's still a class issue around breast augmentation today?

• 36:35Speaker 05

  You know, that still thing, really. It's, you know, just to return to something you were talking about earlier on about it 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.

• 37:17Speaker 05

  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.

• 37:28Kate Lister?

  I'd never thought of it like that. That's very true.

• 37:30Speaker 05

  Now, the problem is, if you then have really small breast implants, who's gonna know?

• 37:36Kate Lister?

  That's true. Go big or go home, right?

• 37:39Speaker 05

  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.

• 38:00Kate Lister?

  Absolutely.

• 38:00Speaker 05

  You know, there might be an academic where, you know, if you look like you've dragged through a hedge backwards, you're assumed to be.

• 38:07Kate Lister?

  I encounter that all the time in this particular arena is there's not much, yeah, it's like they, everyone expects you to look, as you said, dragged through a hedge backwards. And it's, it's fascinating, isn't it, isn't it, about what we associate with big boobs and the, 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, what's the future for boob augmentation, do you think? Where are we going? What new trends?

• 38:41Speaker 05

  I mean, the technology is pretty much the same in terms of implants.

• 38:46Kate Lister?

  I suppose it is, isn't it? It's, could it open, put something in?

• 38:49Speaker 05

  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, you know, slight curviness back again. And so, you know, people getting implants for that would be sort of have, they wouldn't be having enormous ones, they'd be having sort of modest ones.

• 39:32Kate Lister?

  Perky ones.

• 39:33Speaker 05

  Feel a bit more, yeah, they'll make them feel a bit more kind of feminine, right?

• 39:37Kate Lister?

  Yeah.

• 39:38Speaker 05

  Back to the kind of gendering thing, but you know, so different people want different kinds of implants for different reasons.

• 39:47Kate Lister?

  Yeah.

• 39:47Speaker 05

  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 nineties, you kind of get this very, people want very big implants. Sort of now it's you know, much smaller maybe. So there were those things as well. And then, you know, in a way, this is 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 know, you don't have much risk going forward because there isn't an implant there.

• 40:31Speaker 05

  You know, there's still issues to be solved, like capsular contractions. So I think, you know, sort of somewhere, they won't tell you, but somewhere between twenty and forty percent of all breast implants end up going hard because scar tissue builds up around.

• 40:47Kate Lister?

  Okay.

• 40:47Speaker 05

  And so, you know, there's probably going to 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.

• 41:14Kate Lister?

  I think that they probably are, but as long as they're safe or getting safer and we're not injecting ourselves with paraffin anymore.

• 41:21Speaker 05

  Yeah, also all liquid silicone.

• 41:23Kate Lister?

  Oh, thank you so much, Ruth. If people want to find out more about you and your work, where can they find you online?

• 41:29Speaker 05

  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 forty five percent or a guaranteed pension, I should say. And, you know, we're also in dispute over workload and pay and casualisation and inequality.

• 41:58Kate Lister?

  Yep.

• 41:58Speaker 05

  So I didn't want to stay where I am, but if you Google me.

• 42:03Kate Lister?

  And if someone wanted to find you on Twitter or on social media.

• 42:07Speaker 05

  I'm on Twitter, but I don't at the moment, I'm sort of more tweeting as a member of UCU than I am.

• 42:15Kate Lister?

  Solidarity, strong work. I love it. Thank you so much for talking to me, Ruth. You've been absolutely amazing.

• 42:20Speaker 05

  Been great. Thank you.

• 42:22Kate Lister?

  Thank you.

• 43:04Speaker 02

  Hi folks, this is Mark Bittman from the podcast Food with Mark Bittman, and I'm here to suggest that you host Thanksgiving with industry-leading quality standards from Whole Foods Market. There are, as usual, no antibiotics ever in their meat department, so carve up turkey and spiral cut ham with peace of mind. Shop organic sides like stuffing mix and cranberry sauce from 365 brand. And guess what? All of their fabulous delectable pies are made with no high fructose corn syrup. Where else are you going to find that? Gourmet Thanksgiving flavors with the quality you want, only at Whole Foods Market.

• 43:57Kate Lister?

  So Professor Vikram Devaraj, thank you so much for joining me on Betwixt the Sheet. 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 wifi password. So I'm just gonna say that you are the man to talk to about boob jobs, the plastic surgeon extraordinaire.

• 44:21Speaker 04

  That's very kind. I don't think the letters will 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, Devroge WTF are you going on about? Like you're Mr. Boob. I'm not Mr. Boob. There's loads of Mr. Boobs. There's loads of and Miss Boobs and gender neutral boob suppliers. Other options are available. I am, the most I've taken off last week, I took off, oh, it's two weeks ago. Two and a half kilos of breast.

• 44:59Kate Lister?

  I don't think I've got two and a half kilos of breast.

• 45:01Speaker 04

  Taking eight hundred grams, uh, nine hundred grams, a kilo of each breast isn't uncommon. And so many of the patients, that's the point. So many of the patients who come in are coming in for, say, for a breast reduction because they get backache, neck ache, pains, 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, 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 sort of giant parachutes on top of them because they're 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.

• 45:46Speaker 04

  So you've got.

• 45:47Kate Lister?

  That's life changing, isn't it?

• 45:48Speaker 04

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

• 46:07Kate Lister?

  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?

• 46:21Speaker 04

  Just as the name suggests, one is making the breast larger and the other's 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.

• 46:47Kate Lister?

  Yep.

• 46:47Speaker 04

  Or it would be above. And that gets left in place inside you 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 have the nicest silhouette as possible, thinking about the scars, thinking about nipple sensation and thinking about the blood supply.

• 47:11Kate Lister?

  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?

• 47:18Speaker 04

  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 beer bar 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

• 48:01Speaker 04

  it can't cover all of it, it will disguise the kind of edges and the shape and sometimes can look more natural.

• 48:09Kate Lister?

  Ah, okay, so it's not really that like one is better or worse, it's dependent on the patient?

• 48:14Speaker 04

  Absolutely.

• 48:15Kate Lister?

  Uh huh. 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.

• 48:25Speaker 04

  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 misshapen, a bit like a coconut. And in that case.

• 48:48Kate Lister?

  Well, that's not nice. No one wants that.

• 48:49Speaker 04

  Uh, nobody wants that. So in that case, if you either have a, 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.

• 49:06Kate Lister?

  Not a problem, not a problem.

• 49:08Speaker 04

  You have to, and you have to have enough taken away. Two, you have to suck it out and then you have to put it back. And it doesn't always stay where you put it.

• 49:16Kate Lister?

  Ah, right.

• 49:17Speaker 04

  It gets absorbed, sometimes it gets, uh, it can form firm little lumps or nobles. And it doesn't necessarily always look as nice as shape blues attractive. If it did, then it would be great because all of us would be doing it.

• 49:30Kate Lister?

  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.

• 49:40Speaker 04

  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.

• 49:46Kate Lister?

  All right, but I will keep cultivating my belly just in case the, the, just in case the procedure is perfected.

• 49:53Speaker 04

  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 tumor, 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,

• 50:36Speaker 04

  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.

• 50:45Kate Lister?

  That's incredible.

• 50:46Speaker 04

  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 it's 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.

• 51:04Kate Lister?

  Is.

• 51:05Speaker 04

  The only downside, one of the 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.

• 51:17Kate Lister?

  And you wouldn't know.

• 51:18Speaker 04

  Because you wouldn't feel it.

• 51:20Kate Lister?

  Oh.

• 51:21Speaker 04

  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.

• 51:27Kate Lister?

  So it just goes rogue and you could have one overweight boob. That doesn't sound right at all.

• 51:32Speaker 04

  In theory, yeah, you can for sure, because the cells are from a different location, so they'll behave differently for sure.

• 51:39Kate Lister?

  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?

• 51:57Speaker 04

  Yeah, I think you're talking about the P I P, the PIP implants.

• 52:00Kate Lister?

  That's the one.

• 52:01Speaker 04

  So 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 somebody's ivory, amber, all sorts of things. I think the first ever. Implant was in the seventeenth century, eighteenth century. Where nineteen, eighteen ninety five it was, I think, where somebody took a lump, the 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.

• 52:45Speaker 04

  He recognised there was some fat at the back and moved that. It was eighteen ninety five. That was awesome.

• 52:51Kate Lister?

  That is awesome. Do we have any records of how that patient coped afterwards?

• 52:58Speaker 04

  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. In fact, the first commercial implants, if you like, were in the nineteen sixties. And one of the two American, the Texas surgeons who developed it had the idea, I think it was Frank Gero. 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.

• 53:26Kate Lister?

  As you do.

• 53:28Speaker 04

  As you do, and from that, they were the first people in the nineteen sixties, who, in fact, they used a dog called Esmeralda.

• 53:35Kate Lister?

  No, they didn't.

• 53:36Speaker 04

  I don't know what sort of dog it was.

• 53:38Kate Lister?

  They put tits on a dog.

• 53:40Speaker 04

  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, and the dog, I think, coped with the bag for a bit and then probably started to chew it out. But maybe that's going to the gruesome side, but history is gruesome. It's always gruesome.

• 53:57Kate Lister?

  It's very gruesome. They put breast implants on a dog called Esmeralda.

• 54:03Speaker 04

  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, if, you know, 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, you know, a cone round them. That's what they do.

• 54:25Kate Lister?

  Oh, I think we've just discovered a whole new category at Crufts. Dogs with breasts. No, okay, I'm gonna get stuck on that. The woman who had the first breast implants, her name was Timmy, was it? Is that right? Yeah?

• 54:40Speaker 04

  Yeah, it was. I think she'd had about six children and she was in Texas. And I think, I think she went to see them about something else and they just said, while you're here, do you fancy this?

• 54:51Kate Lister?

  We've done this thing to a dog.

• 54:52Speaker 04

  And I think.

• 54:53Kate Lister?

  Do you fancy a guy?

• 54:55Speaker 04

  I'm not sure, I'm not sure they'd mentioned Esmeralda, but you're right, you're absolutely right.

• 55:00Kate Lister?

  And do we know how she is? Is, did they last?

• 55:02Speaker 04

  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.

• 55:10Kate Lister?

  Oh, that's amazing. And have you noticed the trend in breast augmentation changing? I mean, it's, it's kind of like you'd think that if you're just gonna go big, you're gonna go big. But then thinking about it, there are, the big melon shape that Pamela Anderson pioneered in the nineties, 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?

• 55:32Speaker 04

  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, aesthetic or cosmetic change, and even with best 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 sixties for seventies with the Baywatch babe look. There were certain celebrities, I guess you said 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.

• 56:16Speaker 04

  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 it's, 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, we've got lips that look like baboons bottoms. What is the point? It's just, it's not what I want.

• 57:01Speaker 04

  You've got to decide what somebody else wants and at some point someone's going to say, this is ridiculous, enough's enough.

• 57:09Kate Lister?

  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's, 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?

• 57:29Speaker 04

  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, the profession, that the way to actually nurture and foster and engender a good relationship with anybody who are 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 eleven and I think they're going to look like Jessica Rabbit or. I should say, I'm really sorry, I think this is insane, it's crazy, go away, I can't help you.

• 58:10Kate Lister?

  That's good. No, I'm not going to do this for you. Because I read more and more about like 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.

• 58:28Speaker 04

  It's not something you can shop for. BAPRAS, which is our British Association of Plastic Reconstructing Aesthetic Surgeons, BAPS, I'm sorry, the name sounds a bit dodgy.

• 58:37Kate Lister?

  Do they not pronounce it BAPS?

• 58:38Speaker 04

  They, they, this always comes up, it's the British Association of Aesthetic Plastic Surgeons, but BAPS, yep, kind of episodic. They, all the organisations 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, this operation that I've had done to my nose and 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.

• 59:23Speaker 04

  Let alone what qualifications they've got and the public doesn't know. That's what one of the concerns is.

• 59:29Kate Lister?

  It is quite scary, isn't it, that anyone wielding a syringe could be administering Botox or that's quite terrifying.

• 59:36Speaker 04

  I find it scary, I agree with you.

• 59:37Kate Lister?

  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, like all the shows that you mentioned there and like with those 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?

• 1:00:01Speaker 04

  There are two. So whether it's a breast reduction, making it smaller, a breast lift, lifting them up after they've dropped a bit.

• 1:00:09Kate Lister?

  Oh, hello. Right, I didn't know you could get that.

• 1:00:11Speaker 04

  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 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 quake 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?

• 1:00:56Speaker 04

  How long will they last? What if something goes wrong? Did 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 any time we put something in, organisms can land on the surface as they go through.

• 1:01:38Speaker 04

  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 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 or Lidl's or Waitrose and then checking out the checkout with a ka-ching ka-ching job done. It's bonkers.

• 1:02:16Kate Lister?

  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 forty 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?

• 1:02:49Speaker 04

  There are suggestions that 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.

• 1:03:31Kate Lister?

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

• 1:03:49Speaker 04

  So it's a pleasure. And to you too. Thanks, Kate.

• 1:03:57Speaker 04

  The breast is a sweat gland. The breast is a modified sweat gland.

• 1:04:00Kate Lister?

  It's not sexy.

• 1:04:01Speaker 04

  It's about the same. I know it didn't sound sexy, does it? If you said, if you said, have a look at my sweat glands and it did that. No, you just, you just, it's all gonna go horribly wrong. But it is, it's a modified sweat gland that starts life and then if the nipples invaginated and that's why I've got milk line. Cause 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.

• 1:04:46Speaker 04

  And then other people can lose as much weight as they want and their breasts still stay very, very large. Cause it all depends how much fat you've got to how much milk producing tissue and we're all different.

• 1:04:56Kate Lister?

  That's amazing.

• 1:04:57Speaker 04

  To answer your question Sophie, it just feels, it's just like, it's just, it's fat and ducts and gooey bits that come out. Cause when you squeeze a boob, sometimes people will, can produce all sorts of lovely secretions, which I actually find quite attractive, but some of the people don't. Cause 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 duct ectasia. 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.

• 1:05:31Kate Lister?

  A boob has never sounded less sexy.

• 1:05:36Speaker 04

  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.

• 1:05:43Kate Lister?

  It's just tissue that floats.

• 1:05:45Speaker 04

  It's tissue, it's tissue that floats, exactly.

• 1:05:53Kate Lister?

  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 [email protected]. 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 G. The senior producer was Charlotte Long. Join me again, Betwixt the Sheik, The History of Sex, Scandal and Society, a podcast by History Hit. This podcast contains music from Epidemic Sound.

• 1:06:39Speaker 01

  Good news for anyone who's bad at waiting. Black Friday deals at Lowe's are already on. Get up to three free Select, Wall, Craftsman or Cobalt power tools with the purchase of a Select battery kit. Three for free? You better believe it. Plus, Select ladders are up to 50% off. So go ahead, get in there early. Shop Black Friday deals in-store or online now at Lowe's. Valid through 11/18 while supplies last. Free tools vary based on battery kit purchased and location.

• 1:07:08Speaker 01

  The Quarter Pounder with Cheese is made with 100% fresh beef, cooked when you order it. Add hot crispy fries and an iced cold Coke, and hopefully, a lot of napkins. All for $8. Ba-da-ba-ba-ba.