Table of Con­tents | Arti­cle doi: 10.17742/IMAGE.BR.11.1.5 | PDF


Revealing Narratives in Before and After Photographs of Cosmetic Breast Surgeries

Rachel Alpha John­ston Hurst

Abstract: Fem­i­nist cos­met­ic surgery schol­ars have been atten­tive to cos­met­ic breast surg­eries as emblem­at­ic of a range of issues and ques­tions. Breast implant and reduc­tion surg­eries have been ana­lyzed by schol­ars as psy­cho­log­i­cal­ly ben­e­fi­cial, as rep­re­sen­ta­tive of uneth­i­cal prac­tices in the cos­met­ic surgery indus­try, as exem­plar of the objec­ti­fi­ca­tion of women’s bod­ies, and as con­nect­ed to pow­er­ful cul­tur­al ideas about breasts. A curi­ous dearth in pre­vi­ous schol­ar­ship is a suf­fi­cient engage­ment with the ubiq­ui­tous library of pho­tographs that doc­u­ment these pro­ce­dures. This essay dis­cuss­es before and after pho­tographs of cos­met­ic breast surg­eries, which occu­py a lim­i­nal space as med­ical and sex­u­al, ver­i­fi­ca­tion and fan­ta­sy. In this essay, I argue that before and after pho­tographs of cos­met­ic breast surg­eries should be read as reveal­ing of the con­di­tions under which patients and sur­geons oper­ate, rather than sole­ly as proof of an operation’s results. To make this argu­ment, I focus on two exam­ples of before and after pho­tographs – one of a breast aug­men­ta­tion and one of a breast reduc­tion – and guide my analy­sis of the images in rela­tion to nar­ra­tive inter­views with three women who under­went cos­met­ic breast surg­eries.

Resume : Les chercheurs qui se spé­cialisent dans le domaine de la chirurgie plas­tique fémi­nine se sont intéressés à la chirurgie cos­mé­tique du sein comme étant emblé­ma­tique de tout un éven­tail de ques­tions et de sujets. Les implan­ta­tions mam­maires et les opéra­tions de réduc­tion ont été analysées par les chercheurs pour leurs aspects psy­chologiques béné­fiques, pour l’exemple qu’elles offrent de pra­tiques con­traires à la déon­tolo­gie dans l’industrie de la chirurgie plas­tique, pour l’objectification qu’elles font du corps féminin, pour leurs liens pro­fonds avec les idées cul­turelles sur les seins. Curieuse­ment plus rare par­mi toutes ces recherch­es est l’étude de l’omniprésente col­lec­tion de pho­togra­phies doc­u­men­tant ces pra­tiques. Cet arti­cle dis­cute des pho­togra­phies pré- et post- chirurgie plas­tique mam­maire qui occu­pent une place lim­i­naire entre le médi­cal et le sex­uel, entre le véri­fi­able et l’imaginé. Dans cet essai, je pro­pose l’idée que les pho­togra­phies pré- et post- chirurgie plas­tique mam­maire doivent être inter­prétées comme la révéla­tion des con­di­tions dans lesquelles patientes et chirurgiens opèrent, plutôt que comme la sim­ple obser­va­tion du résul­tat de l’opération. Afin de soutenir cet argu­ment, je me con­cen­tre sur deux exem­ples de pho­tos pré- et post—l’une d’une aug­men­ta­tions mam­maire et l’autre, d’une réduction—et je con­duis mon analyse en m’appuyant sur l’interview de trois femmes ayant subi une opéra­tion de chirurgie plas­tique mam­maire.


Femi­nist cos­met­ic surgery schol­ars have been atten­tive to cos­met­ic breast surg­eries as emblem­at­ic of a range of issues relat­ed to embod­ied expe­ri­ences of gen­der and sex­u­al­i­ty. Although some schol­ars have con­sid­ered the role of before and after pho­tographs in adver­tis­ing and deci­sion-mak­ing process­es, they have not giv­en due atten­tion to the high­ly stan­dard­ized style of pho­tog­ra­phy that appears on sur­geons’ web­sites to demon­strate these out­comes. In this essay, I argue that before and after pho­tographs of cos­met­ic breast surg­eries should be read as reveal­ing of the conditions—individual and structural—under which patients and sur­geons oper­ate, rather than sole­ly as proof of an operation’s results. To make this argu­ment, I focus on two exam­ples of before and after photographs—one of a breast aug­men­ta­tion and one of a breast reduction—and guide my analy­sis of the images in rela­tion to nar­ra­tive inter­views with three women who under­went cos­met­ic breast surg­eries. At first glance, the images I dis­cuss are utter­ly unre­mark­able, due to the rep­e­ti­tion of sim­i­lar images on vir­tu­al­ly every web­site adver­tis­ing cos­met­ic breast surgery. How­ev­er, in this essay, I main­tain that when con­sid­ered along­side women’s nar­ra­tives of their cos­met­ic breast surg­eries, the mean­ing of these pho­tographs becomes man­i­fold and sur­pris­ing, much like the expe­ri­ence of under­go­ing the surg­eries them­selves. These images, I argue, exist at the nexus of med­i­cine and sex­u­al­i­ty, past and present, as well as ver­i­fi­ca­tion and fan­ta­sy.

I begin this essay with a syn­op­sis of fem­i­nist analy­ses of cos­met­ic breast surg­eries, which inter­pret these surg­eries var­i­ous­ly as exem­plars of the objec­ti­fi­ca­tion and sex­u­al­iza­tion of women; as psy­cho­log­i­cal­ly ben­e­fi­cial acts that enable patients to feel more at home in their bod­ies; and final­ly, as con­nect­ed to pow­er­ful and mul­ti­va­lent cul­tur­al ideas about breasts. These analy­ses pro­vide a rich and mul­ti­fac­eted con­text for think­ing about the func­tion of pho­tog­ra­phy for cos­met­ic breast surg­eries. After this nec­es­sar­i­ly con­cise sum­ma­ry, I extend a the­o­ret­i­cal frame­work for read­ing my two exam­ples as illu­mi­na­tive of the ter­rain of cos­met­ic breast surg­eries. Kaja Sil­ver­man recent­ly posit­ed that pho­tog­ra­phy is dis­clo­sive, rather than evi­den­tiary; in her words, as an object that is of this world, it is “the world’s pri­ma­ry way of reveal­ing itself to us” (7 and 10). In my book, Sur­face Imag­i­na­tions: Cos­met­ic Surgery, Pho­tog­ra­phy, and Skin, I argued that the con­tem­po­rary con­di­tions of the cos­met­ic surgery indus­try are shaped by the seduc­tive fan­ta­sy that an alter­ation on the sur­face of the body will result in an improve­ment of one’s inte­ri­or life, aligned with a promise that our bod­ies are lim­it­less­ly trans­formable and most of all, con­trol­lable (19). I call this fan­ta­sy “sur­face imag­i­na­tion.” Silverman’s con­tention that the pho­to­graph is dis­clo­sive is provoca­tive to me, as I pre­vi­ous­ly under­stood the use of pho­tographs with­in cos­met­ic surgery as objects of aspi­ra­tional evi­dence. This essay pro­vides an oppor­tu­ni­ty to reflect on how these two ways of under­stand­ing pho­tographs are in ten­sion with and com­ple­ment one anoth­er. Before delv­ing into the pho­tographs, I offer a sketch of the method­ol­o­gy I use to con­nect three nar­ra­tives of cos­met­ic breast surgery by Tonya, Leah, and Melin­da (all pseu­do­nyms), with an analy­sis of two arche­typ­i­cal before and after pho­tographs found online. Con­ceiv­ing of pho­tog­ra­phy as dis­clo­sive push­es me to rethink the func­tion of before and after pho­tographs beyond their more com­mon­ly per­ceived sta­tus as evi­dence. This rethink­ing is a use­ful inter­ven­tion to bet­ter under­stand what these pho­tographs mean to women con­sid­er­ing and under­go­ing cos­met­ic breast surg­eries, as well as their use in med­i­cine and pop­u­lar cul­ture.

Analy­ses of cos­met­ic breast surg­eries exist amongst the ear­li­est fem­i­nist inves­ti­ga­tions into the rela­tion­ship between cul­ture, images, and the cos­met­ic surgery indus­try. These ini­tial dis­cus­sions typ­i­cal­ly pre­sent­ed cos­met­ic breast surg­eries as objec­ti­fy­ing and harm­ful, a capit­u­la­tion to visu­al pref­er­ences gen­er­at­ed by men through the beau­ty and pornog­ra­phy indus­tries. For exam­ple, Kathryn Pauly Mor­gan claims that “de-skin[ning] and alter­ing the con­tours of women’s bod­ies” to look like “man­nequins with large breasts in the shop win­dows of mod­ern patri­ar­chal cul­ture” hap­pens in a con­text where women are sub­ject to “com­pul­so­ry attrac­tive­ness,” which is “defined as attrac­tive-to-men,” and where women are com­pelled to direct their sex­u­al­i­ty towards men (46 and 32). Oth­er ear­ly fem­i­nist approach­es empha­sized the sex­u­al­iza­tion of women’s breasts in cos­met­ic surgery, link­ing breast aug­men­ta­tion with foot bind­ing, as a means to “increase sex­u­al desir­abil­i­ty” (Spitza­ck 39). A com­mon thread that con­nects sev­er­al of the objec­ti­fi­ca­tion analy­ses is a con­cern about the cre­ation of patholo­gies such as “micro­mas­tia” to jus­ti­fy breast implants (Bor­do 44; see also Mor­gan 39-41; Spitza­ck 38). Although con­tem­po­rary analy­ses of cos­met­ic surgery tend to be more nuanced, such analy­ses of breast aug­men­ta­tion con­tin­ue to have an after­life in anti-pornog­ra­phy analy­ses, as well as trans-exclu­sion­ary rad­i­cal fem­i­nist analy­ses of trans­gen­der surg­eries (see Dines; Jef­freys).

Cos­met­ic breast surg­eries are fre­quent­ly explained as hav­ing a ben­e­fi­cial psy­cho­log­i­cal out­come, because patients report they can dwell more eas­i­ly with­in their bod­ies because their inter­nal image of their body is more close­ly aligned with its out­ward appear­ance fol­low­ing surgery. Kathy Davis’s Reshap­ing the Female Body: The Dilem­ma of Cos­met­ic Surgery was the first schol­ar­ly text to take this claim seri­ous­ly. She argues that while cos­met­ic surgery has been sen­sa­tion­al­ized as the domain of the rich, vain, and famous, the major­i­ty of women who under­go cos­met­ic surgery desire to appear “ordi­nary” (Davis 12). More impor­tant­ly, women’s active engage­ment with cos­met­ic surgery resists cul­tur­al expec­ta­tions for women to be pas­sive and com­pli­ant. Davis con­cludes that cos­met­ic surgery can be a means for women to become “embod­ied sub­jects, rather than objec­ti­fied bod­ies” (114). Debra Gimlin’s inter­views with women who under­went breast aug­men­ta­tion reveal that women com­bined the nar­ra­tive that cos­met­ic surgery is psy­cho­log­i­cal­ly ben­e­fi­cial with the nar­ra­tive that they were hard-work­ing peo­ple and thus moral­ly enti­tled to surgery (86-88). These inter­views also show an intrigu­ing align­ment with pop­u­lar dis­cours­es about the impor­tance of self-care for women. As I will dis­cuss short­ly, my inter­views with three women who under­went cos­met­ic breast surg­eries with­in the con­text of a project about cos­met­ic surgery more gen­er­al­ly also reflect­ed the idea that these surg­eries were a form of self-care and tak­ing con­trol of one’s life (Hurst).

And final­ly, fem­i­nist schol­ars have argued that cos­met­ic breast surg­eries can­not be analysed out­side of a broad­er under­stand­ing of the socio-cul­tur­al mean­ings of breasts, par­tic­u­lar­ly those pro­duced by beau­ty and celebri­ty cul­tures, as well as ide­olo­gies of moth­er­hood. With­in a dis­cus­sion of sur­geons’ claims that cos­met­ic sur­gi­cal body mod­i­fi­ca­tions are quick­ly and eas­i­ly inte­grat­ed into patients’ body image, Vir­ginia Blum astute­ly notes that a woman’s sense of her breast implants “belong­ing” to her self-con­cept of her body is lim­it­ed “only inso­far as breasts ever belong to women and are not cul­tur­al­ly cod­ed for visu­al plea­sure, as a sig­ni­fi­er of fem­i­nin­i­ty” (32). Argu­ing that we cur­rent­ly live in a “sur­gi­cal cul­ture” where the body is trans­formed into a two-dimen­sion­al plane through cos­met­ic surgery, Blum sit­u­ates cos­met­ic breast surg­eries as insep­a­ra­ble from the “pub­lic spec­ta­cle of fem­i­nin­i­ty,” which alien­ates women from their bod­ies, par­tic­u­lar­ly parts of the body that are high­ly gen­dered and sex­u­al­ized, like breasts (33). Like Blum, Mered­ith Jones posits that celebri­ty culture—which is high­ly invest­ed in ongo­ing bod­i­ly trans­for­ma­tion to meet con­tem­po­rary trends and demands to appear youth­ful and feminine—is insep­a­ra­ble from how cos­met­ic breast surg­eries are inter­pret­ed (139-43). Both schol­ars note the con­tra­dic­to­ry sta­tus of breasts as both sex­u­al and mater­nal. Ana­lyz­ing breast aug­men­ta­tion through the method­ol­o­gy of the psy­cho­an­a­lyt­ic case study, Alessan­dra Lem­ma argues for a psy­cho­an­a­lyt­ic prax­is that is con­cerned with what effects the sig­nif­i­cant rise in cos­met­ic surgery has on indi­vid­ual psy­chi­cal expe­ri­ences, par­tic­u­lar­ly as patients expe­ri­ence psy­cho­log­i­cal dis­tress post-cos­met­ic surgery (24). In Mind­ing the Body, she devotes a case study to a patient who under­goes breast aug­men­ta­tion in rela­tion to her expe­ri­ences of hav­ing and being a moth­er, which Lem­ma inves­ti­gates through the lens of cul­tur­al ide­olo­gies as well as the patient’s sin­gu­lar expe­ri­ence (23-40).

Each of these fem­i­nist per­spec­tives has addressed, to vary­ing degrees, the rela­tion­ship between the ide­al­ized image and the body. The insights of these schol­ars guide my analy­sis in Sur­face Imag­i­na­tions, which the­o­rizes that the pho­to­graph is the ide­al­ized sur­face of the cos­met­ic surgery indus­try, coun­ter­posed against the skin as the de-ide­al­ized sur­face. The pho­to­graph is capa­ble of inter­minable trans­for­ma­tion, with­out the pain or time required to recov­er phys­i­cal­ly, or the uncer­tain­ty of the results of an oper­a­tion. For these rea­sons, I con­cep­tu­al­ized the pho­to­graph as “reminder, evi­dence, and promise” in cos­met­ic surgery (92). The skin, on the oth­er hand, is uncon­trol­lable: it bleeds, hurts, scars, and changes through­out time, no mat­ter what we do.

I did not enter into this project with the inten­tion of inquir­ing into the sta­tus of pho­tographs in cos­met­ic surgery; how­ev­er, my inquiry into surgeon’s web­sites, women’s mag­a­zines, and inter­views led me to sit­u­ate the pho­to­graph as cen­tral to cos­met­ic sur­gi­cal prac­tice. I was par­tic­u­lar­ly sur­prised by the degree to which pho­tog­ra­phy func­tioned as a medi­um for patients to visu­al­ize the effects of a cos­met­ic surgery on their body, as well as how my inter­vie­wees used pho­tog­ra­phy as a way of doc­u­ment­ing the changes to their body, which I explore exten­sive­ly in my book. I came to see pho­tographs as pri­mar­i­ly items of evi­dence in cos­met­ic sur­gi­cal prac­tice, and I locat­ed these pho­tographs with­in a vari­ety of oth­er iden­ti­ty and evi­den­tiary pho­tographs like driver’s licens­es and mug shots (113-15). Fur­ther, I argued that pho­tographs of cos­met­ic surgery act as fan­ta­sy objects that pro­vide evi­dence as either mem­o­ries of pre­vi­ous embod­i­ments or assur­ances of poten­tial embod­i­ments.

In her recon­sid­er­a­tion of the his­to­ry of pho­tog­ra­phy, Sil­ver­man pro­pos­es that we rethink the pho­to­graph as not the inven­tion of a hand­ful of men, not as an object with an index­i­cal rela­tion­ship to its sub­ject, but rather as an onto­log­i­cal and social rev­e­la­tion (87). In this refram­ing, pho­tog­ra­phy is a fun­da­men­tal­ly human activ­i­ty that “devel­ops … with us and in response to us” (Sil­ver­man 12). Pho­tographs are not rep­re­sen­ta­tions of some­thing that is no longer there, but instead they are recep­tive sur­faces through which the world dis­clos­es itself to us through the cam­era in a sin­gu­lar fash­ion that is rad­i­cal­ly dif­fer­ent from our look (Sil­ver­man 47 and 123). Sil­ver­man devel­ops her analy­sis through a delib­er­a­tion on ear­ly pho­tographs (daguerreo­types, and those pro­duced by the cam­era obscu­ra, for exam­ple), as well as con­tem­po­rary fine art pho­tographs (par­tic­u­lar­ly those cre­at­ed by artists who reclaim ear­ly pho­to­graph­ic prac­tices). She does not dis­cuss the impli­ca­tions of her argu­ment for con­tem­po­rary ver­nac­u­lar pho­tog­ra­phy and dig­i­tal pho­tog­ra­phy, yet as this is the first in a three-vol­ume series, it is pos­si­ble that she will do so in the future. This argu­ment is pro­found­ly dif­fer­ent from how I under­stood pho­tog­ra­phy in Sur­face Imag­i­na­tions, where I empha­sized the evi­den­tiary qual­i­ties of cos­met­ic surgery pho­tographs. Silverman’s insight com­pels me to push my analy­sis fur­ther to ask what impres­sions of the cos­met­ic surgery indus­try and encounter exist in ordi­nary before and after pho­tographs.

When pho­tog­ra­phy is con­sid­ered an index or as evi­dence, images pos­sess a qual­i­ty of “past­ness,” in that the ref­er­ent exists in the his­tor­i­cal moment of the pho­to­graph (Sil­ver­man 2-3). In this con­cep­tu­al­iza­tion, pho­tographs are dis­pas­sion­ate objects of remem­brance or con­fir­ma­tion, faith­ful­ly encom­pass­ing the past in an image. Before and after pho­tographs of cos­met­ic breast surg­eries enclose two dis­crete moments in breast­ed life, moments that view­ers under­stand as sep­a­rate: “before” is past, and “after” is present. In this way, the use of before and after pho­tographs both relies on and dis­turbs the qual­i­ty of “past­ness” that index­i­cal or evi­den­tiary under­stand­ings of pho­tog­ra­phy pos­sess. This is because before and after pho­tographs invite the view­er to con­sid­er the trans­for­ma­tion of the patient’s body in the present and also to imag­ine the pos­si­bil­i­ty of trans­for­ma­tion in their own future. Work­ing with Silverman’s exe­ge­sis of Wal­ter Benjamin’s ear­ly work on pho­tog­ra­phy, pho­to­graph­ic images are not fixed, but rather devel­op­men­tal, reach­ing through time and space for a look that could “rec­og­nize” and “redeem” an image (7). When a pho­to­graph­ic image reach­es a look of recog­ni­tion and redemp­tion, “the present dis­cov­ers itself with­in the past, and the past is real­ized with­in the present” (Sil­ver­man 7). Before and after pho­tographs of cos­met­ic breast surg­eries have been con­sid­ered by many schol­ars (includ­ing me) to fix bod­ies in time for the dual pur­pos­es of adver­tis­ing a surgeon’s skill and nar­rat­ing a patient’s bod­i­ly trans­for­ma­tion. The past is reject­ed as abnor­mal or defi­cient and the present is cel­e­brat­ed as a vic­to­ry. How­ev­er, if I fol­low Sil­ver­man, before and after pho­tographs can also be thought of more dis­rup­tive­ly: not as lin­ear nar­ra­tives that sep­a­rate past from present, but as mutu­al­ly con­sti­tu­tive and dis­clo­sive of the indi­vid­ual and struc­tur­al fac­tors that shape how patients obtain surgery.

I work from the premise that even the most mun­dane pho­tographs of cos­met­ic surgery are not trans­par­ent and know­able, but instead that before and after pho­tographs can be read as part of a sys­tem of signs point­ing to the fan­tasies of the cos­met­ic surgery indus­try. Typ­i­cal­ly, pho­tographs like the ones I dis­cuss in this essay are dis­missed as banal and unin­ter­est­ing, or as manip­u­lat­ed and unre­li­able. Thus, they are not typ­i­cal­ly the mate­r­i­al of schol­ar­ly con­sid­er­a­tion, which prefers extra­or­di­nary exam­ples like “extreme” makeovers, artists who use cos­met­ic surgery, or fic­tion­al explo­rations of the before and after image in visu­al cul­ture. As a result, ordi­nary pho­tographs of cos­met­ic surg­eries are under-the­o­rized and pre­sent­ed as though they can be read trans­par­ent­ly (if they are pre­sent­ed at all). My research is inter­est­ed in nov­el ways to under­stand the embod­ied expe­ri­ence of under­go­ing cos­met­ic surgery, an expe­ri­ence in which patients nav­i­gate a com­plex visu­al ter­rain of indi­vid­ual desires and socio-cul­tur­al ideals. This com­plex­i­ty leads me to use cre­ative method­olo­gies like poet­ic tran­scrip­tion (using inter­view tran­scripts to craft texts inspired by the con­ven­tions of poet­ry) in order to inves­ti­gate the mean­ing of cos­met­ic surgery for those whose lives inter­sect with its ide­olo­gies and prac­tices (Hurst 34-40). Here, I pro­pose that anoth­er cre­ative and spec­u­la­tive way to bet­ter under­stand my inter­views with cos­met­ic breast surgery recip­i­ents is through expand­ed inquiry into the kinds of before and after pho­tographs they described in our con­ver­sa­tions. My analy­sis in this essay builds on, and extends my ear­li­er work on these inter­views, which were analysed through a ground­ed the­o­ry approach that con­sid­ered the inter­view as an inter­sub­jec­tive and inter­tex­tu­al com­mit­ment (see Glaser and Strauss; Clarke; Char­maz; Shostak). Rather than take these images for grant­ed, I recon­sid­er them through the lens of Silverman’s argu­ment that pho­tographs are a way that the world (of cos­met­ic surgery) reveals itself to us as view­ers.

Specif­i­cal­ly, I think that Silverman’s argu­ment has pro­found con­se­quences for how we look at pho­tographs such as these:

Fig­ure 1. Otto Placik, Patient No. 7181-Dr. Placik-Breast Reduc­tion, Chica­go Illi­nois-Arling­ton Heights-four-plate pho­to­graph, Wiki­me­dia Com­mons, 17 July 2011, https://​com​mons​.wiki​me​dia​.org/​w​i​k​i​/​F​i​l​e​:​P​a​t​i​e​n​t​_​N​o​.​_​7​1​8​1​-​D​r​.​_​P​l​a​c​i​k​-​B​r​e​a​s​t​_​R​e​d​u​c​t​i​o​n​,​_​C​h​i​c​a​g​o​_​I​l​l​i​n​o​i​s​-​A​r​l​i​n​g​t​o​n​_​H​e​i​g​h​t​s​-​f​o​u​r​-​p​l​a​t​e​_​p​h​o​t​o​g​r​a​p​h​.​jpg.
Fig­ure 2. Otto Placik, Dr. Placik Breast Aug­men­ta­tion, Wiki­me­dia Com­mons, 26 June 2009, https://​com​mons​.wiki​me​dia​.org/​w​i​k​i​/​F​i​l​e​:​D​r​.​_​P​l​a​c​i​k​_​B​r​e​a​s​t​_​A​u​g​m​e​n​t​a​t​i​o​n​.​jpg.

Fig­ures 1 and 2 are before and after pho­tographs of breast reduc­tion surgery (fig­ure 1) and breast aug­men­ta­tion surgery (fig­ure 2). These surg­eries were per­formed by Dr. Otto J. Placik, a plas­tic sur­geon prac­tic­ing in Chica­go, who uploaded sev­er­al pho­tographs of his surg­eries to Wiki­me­dia Com­mons, because he “believe[s] a pic­ture is worth a thou­sand words” (Placik). My selec­tion of these two pho­to­graph­ic sets is dri­ven by their free-use sta­tus, as Placik reg­is­tered them with Cre­ative Com­mons. Pho­tographs like these can be locat­ed on vir­tu­al­ly any web­site of a cos­met­ic sur­geon who offers cos­met­ic breast surgery as a part of their prac­tice. How­ev­er, my deci­sion not to choose pho­tographs direct­ly from a surgeon’s web­site stems from the assump­tion that patients would know their pho­tographs were being used by their sur­geon, but not expect them to be used oth­er­wise, as they might with an image uploaded to an open access media repos­i­to­ry. The pho­tographs are arranged in a grid that would be called a “full-face” view and a “three-quar­ter” view, if we were look­ing at facial por­traits; it should be not­ed that the two views give the appear­ance of height­ened objec­tiv­i­ty, as it is quite com­mon not to include the three-quar­ter view in sur­geons’ before and after gal­leries. These two per­spec­tives aim to give the view­er a sense of the visu­al attrac­tive­ness of the patient’s breasts, as well as their size and vol­ume. The pho­tographs begin at the patients’ necks, and end at their waist or hips. We read the images from left to right, as though read­ing Eng­lish text, and the pho­tographs on the right osten­si­bly show the view­er what has hap­pened as a result of the surgery. The pho­tographs on the left-hand side—the “before” images—attempt to show the view­er what is patho­log­i­cal about the patient’s breasts; on the right, the view­er is encour­aged to make an assess­ment of how suc­cess­ful the sur­geon was in cor­rect­ing the pathol­o­gy.

The style of these pho­tographs encour­ages an objec­ti­fy­ing gaze, as the view­er sees only a de-indi­vid­u­at­ed tor­so that seems curi­ous­ly dis­em­bod­ied even though all we see is a body. Deb­o­rah Lup­ton observes that “the iconog­ra­phy of med­ical adver­tis­ing is a reveal­ing insight” into the dis­con­nec­tion between doc­tors and patients, as no body con­tact is implied through the image, which frag­ments the body into pieces and strips the patient of their indi­vid­u­al­i­ty through a dehu­man­iz­ing and anony­mous encounter (72). Arranged in a makeover style of trans­for­ma­tion, the “after” pho­tographs locate the surgery as the cen­tral change to the body, even though oth­er ele­ments of the women’s bod­ies have changed in order to make the “after” image more nor­ma­tive­ly flat­ter­ing through weight loss, jew­ellery, and tan­ning. But most notably, as view­ers we have no con­cept of how much time has passed since the women under­went their surg­eries, which would have inevitably caused swelling, bruis­ing, and scar­ring. Some scar­ring is vis­i­ble in the “after” pho­tographs of the breast reduc­tion, although the size and coloura­tion of the scars sug­gest that they were tak­en some time after the oper­a­tion, and no scar­ring what­so­ev­er is appar­ent in the “after” pho­tographs of the breast aug­men­ta­tion. The makeover fram­ing of the pho­tographs dimin­ish­es the real­i­ty that these women under­went surgery, even though the “before” pho­tographs (unusu­al­ly) con­tain signs of a med­ical envi­ron­ment, as one woman is appar­ent­ly receiv­ing intra­venous flu­ids and the oth­er woman is wear­ing a ban­dage on her inner elbow, as though she has recent­ly had a blood draw. And of course, the makeover frame­work lessens our aware­ness of the pain and dis­com­fort involved in recov­er­ing from cos­met­ic breast surg­eries.

The use of the makeover trope in before and after pho­tographs by cos­met­ic sur­geons sug­gests an equiv­a­lence between chang­ing one’s appear­ance through make­up, diet­ing, and hair­styling and chang­ing one’s appear­ance through surgery. In Sur­face Imag­i­na­tions, I brought togeth­er Eliz­a­beth A. Ford and Deb­o­rah C. Mitchell’s analy­sis of movie makeover nar­ra­tives with Kathy Davis’ analy­sis of cos­met­ic surgery nar­ra­tives. Both tropes define the makeover or surgery as a defin­ing moment of the protagonist’s life; as an out­come or reward for suf­fer­ing through hard­ship; as defined by a series of delib­er­a­tions; and as a way to con­firm one’s iden­ti­ty (Hurst 64-66). The com­bi­na­tion of cos­met­ic surgery and movie makeover nar­ra­tives, in a range of pho­to­graph­ic prac­tices appar­ent in women’s mag­a­zines, surgeon’s web­sites, and per­son­al pho­tographs, con­ceals more than reveals what hap­pens in cos­met­ic surgery (Hurst 72). Although I would still main­tain that this is accu­rate when con­sid­er­ing the sur­gi­cal process and heal­ing peri­od fol­low­ing a surgery, Silverman’s re-eval­u­a­tion of the dis­clo­sive poten­tial of pho­tog­ra­phy encour­ages me to recon­sid­er what before and after pho­tographs might reveal of the con­di­tions under which patients engage with the cos­met­ic surgery indus­try. Through this process of recon­sid­er­a­tion, I was sur­prised to find that these some­what mun­dane pho­tographs did express themes of my inter­views con­duct­ed with three women who under­went cos­met­ic breast surg­eries, even though they reveal very lit­tle about the process of under­go­ing surgery.

I inter­viewed three women in 2007 and 2008 who had under­gone cos­met­ic breast surg­eries, which formed part of the research for my book. Tonya and Leah received breast reduc­tion surg­eries that were cov­ered by provin­cial health insur­ance. Tonya’s surgery hap­pened nine years before we met, while Leah’s surgery was com­par­a­tive­ly recent, hav­ing occurred just over a year before our inter­view. Although a com­mon­ly-held assump­tion is that breast reduc­tion surgery is a med­ical­ly nec­es­sary pro­ce­dure, patients—especially those who have access to gov­ern­ment-fund­ed health insurance—indicate that fram­ing breast reduc­tion as “med­ical­ly nec­es­sary” or as “recon­struc­tive” surgery is instead a suc­cess­ful strat­e­gy to gain access to fund­ed cos­met­ic surgery (see Nau­gler, “Cross­ing” and To Take a Load Off). This was true for both Tonya and Leah, who dis­cussed their surg­eries in cos­met­ic and emo­tion­al terms, as both inter­vie­wees had expe­ri­enced a kind of hyper-vis­i­bil­i­ty as well as unwant­ed sex­u­al atten­tion as a result of their large breasts. Melin­da under­went breast aug­men­ta­tion surgery at a pri­vate­ly-run clin­ic and paid for her own surgery. This is typ­i­cal for Cana­da, with the excep­tion of breast implants that women receive after a mas­tec­to­my, which is clas­si­fied as a “recon­struc­tive” surgery. Her surgery occurred three to four years before our inter­view (she could not remem­ber exact­ly when the surgery hap­pened). Melin­da explained that her surgery was a way to reclaim her body after an abu­sive rela­tion­ship, and fur­ther, as a return to the way her breasts looked when she was preg­nant and breast­feed­ing her daugh­ter, a time when she felt pow­er­ful in her embod­i­ment. This is a nec­es­sar­i­ly brief intro­duc­tion to these inter­vie­wees, and more detailed infor­ma­tion and analy­sis about their expe­ri­ences of com­ing to, under­go­ing, and liv­ing after cos­met­ic surgery can be found in my book. For now, I would like to turn back to the before and after pho­tographs of breast reduc­tion and aug­men­ta­tion in rela­tion to Tonya’s, Leah’s, and Melinda’s nar­ra­tives of their surg­eries.

Tonya described her con­sul­ta­tion appoint­ment as a pro­found­ly dis­em­bod­ied and “very degrad­ing” expe­ri­ence, where her breasts—which were a “heavy source of shame” for her—were treat­ed as though they were not a part of her body, and instead as objects to be eval­u­at­ed as either “too big … too ugly … too sag­gy” through pho­tog­ra­phy. Based on the way Tonya described the process of being pho­tographed “from the front and side” in order to be assessed by a “review pan­el … a face­less pan­el of doc­tors” who would deter­mine whether or not her surgery was eli­gi­ble for provin­cial health insur­ance cov­er­age, the pho­tographs on the left in fig­ure 1 could be the out­come of the appoint­ment she described. Tonya also dis­cussed look­ing at after pho­tographs of breast reduc­tion surg­eries in a “stan­dard text­book” that her sur­geon offered in response to her request to see what scar­ring she could expect. While Tonya was crit­i­cal of how the pho­tographs of her breasts would be used to visu­al­ly assess her eli­gi­bil­i­ty for insur­ance cov­er­age based on appear­ance rather than med­ical need, she accept­ed the real­ism of the pho­tographs such as those in fig­ure 1.

Leah, on the oth­er hand, had looked at some breast reduc­tion pho­tographs on the Inter­net and was not con­vinced that they pro­vid­ed an accu­rate rep­re­sen­ta­tion of sur­gi­cal results. She linked this increduli­ty with the com­mon­place idea that it is unwise to seek med­ical infor­ma­tion from the Inter­net, as the risks will always be exag­ger­at­ed. Unlike Tonya, Leah did not have pho­tographs tak­en as a part of her intake appoint­ment. Nev­er­the­less, her expe­ri­ence of being assessed in the clin­ic is also present in fig­ure 1. Because she did not trust the evi­den­tiary pow­er of pho­tographs, Leah felt that she need­ed to place her trust in the sur­geon instead. Although she described him as a “nice man” and a “good” sur­geon, her descrip­tion of being assessed by him was not flat­ter­ing. He was in the con­sul­ta­tion room for just five min­utes, “flicked open” her hos­pi­tal gown, and treat­ed her breasts and body as though he “was a mechan­ic deal­ing with parts.” The ster­ile and detached dis­po­si­tion of fig­ure 1 dis­clos­es this expe­ri­ence, as the view­er is not encour­aged to see the sub­ject as a per­son enter­ing into a med­ical rela­tion­ship to change a part of her body that might be asso­ci­at­ed with a range of feel­ings relat­ed to sex­u­al­i­ty, mater­ni­ty, shame, and pathol­o­gy, but instead as “parts” that can be “dealt with.” The frag­ment­ed body in fig­ure 1 uncov­ers the vul­ner­a­bil­i­ty and objec­ti­fi­ca­tion in the encounter, as well as the expe­ri­ence of hav­ing one’s breasts manip­u­lat­ed and eval­u­at­ed as though they are entire­ly sep­a­rate from one’s self.

One sig­nif­i­cant dif­fer­ence between fig­ure 1 and fig­ure 2 is the pres­ence of scar­ring in fig­ure 1. This scar—which encir­cles the woman’s nip­ples and runs down ver­ti­cal­ly toward the crease where her breasts and tor­so meet—has a visu­al func­tion in the pho­to­graph that is par­al­lel to the pop­u­lar assump­tion that breast reduc­tion surgery is a recon­struc­tive, med­ical­ly nec­es­sary pro­ce­dure. The scar’s appari­tion sug­gests and rein­forces the idea that patient and sur­geon are less con­cerned with the cos­met­ic out­come and that this surgery has been done for func­tion­al rea­sons. Its visu­al pres­ence repli­cates the sig­nif­i­cance of the scar for both Leah and Tonya. Leah’s moti­va­tion to seek breast reduc­tion surgery orig­i­nat­ed in the shame she felt about the stretch marks net­worked across her breasts; in con­trast to these, sur­gi­cal scars were not con­cern­ing in the least. Tonya made a deci­sion to nev­er be ashamed of her sur­gi­cal scars and con­tra­dic­to­ri­ly described her scars as “big and dis­gust­ing and ugly” but also “actu­al­ly quite good.” She cre­at­ed a reg­i­men of care to min­i­mize the size and improve the appear­ance of her scars, which includ­ed the use of turmer­ic and rose­hips. Melin­da also spoke about scar­ring, say­ing that while her breast aug­men­ta­tion scars were larg­er than usu­al, they were also “not notice­able” and “fad­ed.” Fig­ure 2 is marked­ly dif­fer­ent, as the scar left by insert­ing breast implants into the patient’s chest is pos­si­bly con­cealed in the creas­es under­neath her breasts, some­thing which Melin­da men­tioned when she said that her scars were not appar­ent. In fig­ure 2, it appears that the patient’s breasts have mirac­u­lous­ly grown, but are oth­er­wise not sub­stan­tial­ly dif­fer­ent in shape or loca­tion.

Intrigu­ing­ly, the depic­tion of breasts in fig­ure 2 is reveal­ing of how Melin­da dis­cussed her hopes for her breast aug­men­ta­tion surgery, rather than her inter­ac­tions with her sur­geon. Melin­da con­sult­ed the pho­to­graph gallery on her surgeon’s web­site and was reas­sured that he had oper­at­ed on women who var­ied in body and breast size, and that he also per­formed breast reduc­tion and lift­ing surgery. She rem­i­nisced fond­ly about her expe­ri­ences of being preg­nant and breast­feed­ing her daugh­ter, which was a time when her “body changed a lot” because she “had breasts” and felt “more fem­i­nine and sex­i­er and curvi­er.” This trans­for­ma­tion was almost mag­i­cal, and facil­i­tat­ed an expe­ri­ence of embod­i­ment that was pow­er­ful and dif­fer­ent from her self-con­cept as a “heady” per­son who didn’t pre­vi­ous­ly care that she had small breasts. Melinda’s nar­ra­tive about her breasts grow­ing dur­ing preg­nan­cy and child­birth is uncom­pli­cat­ed and does not involve a dra­mat­ic change. This was the expec­ta­tion that she held about her breast aug­men­ta­tion, which she hoped would return her to this for­mer embod­i­ment where her breasts were “small, and nat­ur­al.” Here, fig­ure 2 dis­clos­es the wish­es inform­ing the deci­sion to under­go breast aug­men­ta­tion surgery, as well as Melinda’s sat­is­fac­tion and hap­pi­ness with her out­come. Sig­nif­i­cant­ly, Melin­da said that she “liked [her] breasts all of a sud­den,” a dec­la­ra­tion that echoes the imme­di­a­cy of the trans­for­ma­tion in fig­ure 2.

As rep­re­sen­ta­tives of con­ven­tion­al before and after pho­tographs of cos­met­ic breast surg­eries, my analy­sis of fig­ures 1 and 2 in rela­tion to inter­view nar­ra­tives about breast reduc­tion and aug­men­ta­tion indi­cates that such pho­tographs do hold a dis­clo­sive dimen­sion that I had nev­er con­sid­ered. When read dis­clo­sive­ly, look­ing at before and after pho­tographs of cos­met­ic breast surg­eries is an act of recog­ni­tion that reveals the body in trans­for­ma­tion and the pow­er dynam­ics of the patient-sur­geon rela­tion­ship. This dis­clo­sive dimen­sion exists along­side the instru­men­tal use of before and after pho­tographs as evi­dence of a surgery, a use which I have argued con­ceals more than it reveals (73). For exam­ple, what con­tin­ues to be invis­i­ble in fig­ures 1 and 2 is the severe pain, swelling, and bruis­ing that Tonya described as “look[ing] like I’d gone through a Mack truck,” the dehy­dra­tion and adverse reac­tion to pain med­ica­tion that led Melin­da to an emer­gency room two days after her surgery, and the dis­com­fort Leah expe­ri­enced when deal­ing with drainage tubes for the week fol­low­ing her surgery. These exam­ples of what is unseen in before and after pho­tographs of cos­met­ic breast surg­eries sug­gest that their com­mon use as evi­dence of a surgery is one that intends to be per­sua­sive through dimin­ish­ing what is painful and unpleas­ant about heal­ing.

Before and after pho­tographs of cos­met­ic breast surgery are “pred­i­cat­ed on [a] con­ceit of imme­di­a­cy and visu­al order,” reveal­ing a desire to cor­rect and con­trol the dis­rup­tive body pre­sent­ed in the before image (Hannabach 356). An analy­sis of before and after pho­tographs of cos­met­ic breast surg­eries as dis­clo­sive is sig­nif­i­cant in the con­text of ongo­ing strug­gles for author­i­ty over the inter­pre­ta­tion and cre­ation of med­ical images at the inter­sec­tion of sci­ence and pop­u­lar cul­ture (Tre­ich­ler et al. 9). Reflect­ing on the dis­clo­sive qual­i­ties of Fig­ure 1 and Fig­ure 2 through the lens of nar­ra­tives of cos­met­ic breast surg­eries makes room for an inter­pre­ta­tion that con­sid­ers not just the results of a surgery (evi­dence), but also the con­di­tions that patients nav­i­gate as they estab­lish rela­tion­ships with sur­geons. Ordi­nary before and after pho­tographs of cos­met­ic breast surg­eries can facil­i­tate a bet­ter under­stand­ing of patients’ hopes for surgery, as well as their expe­ri­ences of the con­sul­ta­tion process, which are inscribed onto the photograph’s sur­face. Recon­sid­er­ing these pho­tographs through Silverman’s insight that pho­tog­ra­phy reveals some­thing about the world com­pels me toward a more nuanced and changed under­stand­ing of Tonya’s, Leah’s, and Melinda’s nar­ra­tives. Thus, while I con­tin­ue to inter­pret these pho­tographs as con­ceal­ing the process of recov­ery and heal­ing, I addi­tion­al­ly under­stand them as reveal­ing a par­tial view of the world of cos­met­ic surgery to their view­ers. Think­ing through such pho­tographs not only as evi­den­tiary, but also as dis­clo­sive, opens up a poten­tial avenue of analy­sis for researchers inter­est­ed in visu­al cul­ture and embod­i­ment.

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—. To Take A Load Off: A Con­tex­tu­al Analy­sis of Gen­dered Meaning(s) in Expe­ri­ences of Breast Reduc­tion Surgery. Dis­ser­ta­tion, Depart­ment of Women’s Stud­ies, York Uni­ver­si­ty, 2004.

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