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Buoyed by bigger breasts

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Think Salma Hayek.

That's the look Monica Munro was going for when, after thinking about it for half her life, she finally went ahead and got breast implants in May.

"I look proportionate now," says the 5-foot-2 Munro, who went from "barely A"-cup breasts to 34DD, "bordering on E."

"I used to look very, very bottom heavy," she says.

Log onto, and you'll see postings from lots of women such as Munro, a 36-year-old married mother of two who lives in Moorhead, Minn., just across the Red River from Fargo, N.D. Once the domain of strippers and starlets, breast augmentation appears to be catching on with increasing numbers of soccer moms.

"The typical person getting breast implants today is not the stripper, the model," says St. Louis plastic surgeon Leroy Young, who has been in practice for 26 years. "It's the girl down the street."

From 2000 to 2005, the number of U.S. women who enlarged their breasts with implants jumped 37%, according to the American Society of Plastic Surgeons. Now that the Food and Drug Administration last month approved silicone-gel implants -- generally considered more aesthetically pleasing than salt-water-filled -- for breast augmentation, the procedure is expected to become even more popular.

"It's becoming more and more accepted," says Nicole Cummings, who created eight years ago because she was frustrated with a lack of information about breast augmentation.

"I don't think it's frowned upon as much as when I had it done back in 1998 when it wasn't talked about as openly," Cummings says.

In 1998, according to the plastic surgeons' society, 132,378 U.S. women had their breasts augmented -- fewer than half as many who had the operation in 2005.

In a 2003 survey funded by the Aesthetic Surgery Education and Research Foundation, Cummings asked women who logged onto her site about their age, income, education and marital status. The average age of the 3,500 respondents who had implants and the 1,625 considering them was 34. Three-quarters said they were married or in a long-term relationship. Nearly half said they had a bachelor's degree.

Considering that the cost of breast augmentation, which is not covered by insurance, starts at around $4,000, it's not surprising that nearly three-quarters reported earning $50,000 or more.

Growing up in a small Minnesota town, Jennifer Uphoff never heard of any woman having an operation to enlarge her breasts. Although her five brothers teased her about her 34AA breasts, Uphoff says, "there was such a stigma at that time" about augmentation surgery.

But then she and her husband moved three years ago to Queen Creek, Ariz., and she started meeting women who had had tummy tucks and breast implants.

"It seems a little bit more accepting here," says Uphoff, a slim, 5-foot-10 mother of two who will be 33 in January. "I felt more comfortable looking into it."

'Relentless bombardment'

David Sarwer, a University of Pennsylvania psychologist who studies people's attitudes toward cosmetic surgery, cites several reasons for the soaring number of women choosing breast augmentation: shorter recovery times, thanks to improved surgical techniques; direct-to-consumer advertising by implant manufacturers and surgeons; reality-based cosmetic surgery television shows; and the culture of celebrity, as seen on television and in magazines and movies.

"We're bombarded by this ideal of beauty more so than any other time in history," Sarwer says. "That kind of relentless bombardment takes a toll, because inevitably we compare ourselves to these ideals."

Today, he says, the embodiment of beauty is the thin, muscular actress with unnaturally large breasts. And no matter how attractive they appear to others, many women feel they fall short. "Body image is really the way we see our external appearance in our mind," Sarwer says.

Sometimes, the gap between body image and mirror image is extreme. People who are excessively preoccupied with a real or imagined defect in their appearance are said to suffer from body dysmorphic disorder, or BDD, a psychiatric condition formally recognized only a decade ago.

Research shows at least 7% of cosmetic surgery patients, and that includes at least 7% of women undergoing breast augmentation, have BDD, Sarwer says. And, he says, while more than 90% of women without BDD are satisfied with their breast implants, more than 90% of those with BDD aren't.

Young, half of whose practice is devoted to breast augmentation, says he asks all prospective patients to complete a lengthy questionnaire asking how happy they are with various aspects of their appearance and why they want to have surgery.

"The vast majority of them will say, 'I want to be more proportionate, I want to fit in my clothes better.'"

Uphoff, who has short hair, says she wanted to be able to put on a T-shirt and not be mistaken for a boy. "I'd go into the stores and try to put on a top, and they just never looked the way I hoped they'd look."

Now that she's a full C cup, thanks to breast augmentation surgery in May, Uphoff says, she loves to shop.

Before having her two children, Pam Thorson, of Fargo, N.D., was a B or C cup. But each of her pregnancies "stretched out" her breasts to an EE or F cup. After she stopped breast-feeding her two children, her breasts shrunk and sagged. Clothes didn't fit right.

What do women want?

All of the breast augmentation patients interviewed for this story said their surgeons questioned them thoroughly about why they wanted to have the operation.

But with growing numbers seeking breast augmentation, Sarwer says he worries relatively inexperienced doctors will not take the time to evaluate women's motives, leading to dissatisfied customers or worse.

About a half-dozen population-based studies have found higher suicide rates among women who had breast augmentation surgery than those who hadn't, Sarwer says. And, he says, one study found higher rates of hospitalization for psychiatric conditions before surgery in breast augmentation patients than in women who underwent breast reduction or other cosmetic surgery. One hypothesis is that some women want breast augmentation because they mistakenly think it will save a floundering marriage.

"I don't screen every patient who comes in, but I do get referrals from my surgeon colleagues here at Penn and in the community when they think they have a problematic patient," Sarwer says. "The evidence does not support the notion that everyone who comes in for cosmetic surgery has significant psychopathology."

A good cosmetic surgery candidate is someone who is doing it for herself, Sarwer says, acknowledging that it can sometimes be difficult to determine a patient's true motives.

"I think people often assume that the pressure on women in relationship to their bodies is male," says psychologist Kate Gleeson of the University of Bristol in England.

Actually, Gleeson says, "a lot of the discussion about the size of their breasts is in relation to other women. They tend not to talk about pressure from boyfriends or partners. Women want other women to regard them as feminine and attractive to men."

None of the women interviewed for this story said they got implants because their husbands wanted them to, although they say the men have been pleasantly surprised with the results.

"He was never a boob man before, but he is now," Uphoff, who had saline implants, says of her husband of 12 years.

When Thorson first raised the subject of implants, her husband told her, "You are so sexy, you are so attractive, you don't need to do this." After she gave him more information about the procedure, "he started feeling a little better about it," and their two grown children also gave her their blessing.

Thorson, a nurse who will turn 51 on New Year's Eve, got saline implants in May. She's now a 34D or 34DD, depending on the bra. Although neither she nor her husband expected the implants to make a difference in their relationship, Thorson says, "it definitely has helped. We're like a couple of kids again."

Munro, who became friends with Thorson via, has been married for 10 years.

Before her surgery, her husband told her, "Look, you can go the rest of your life without them (implants), and I will love you no less," she says. "Now, he's completely happy. He's my biggest fan. Very enthusiastic."

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© Copyright 2006 USA TODAY, a division of Gannett Co. Inc.

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