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their own health but also out of concern for other women who are considering breast implants. Many women support the continued availability of breast implants for those who want them for either augmentation or reconstruction, with the proviso that adequate information regarding potential complications and long-term safety is available to them for informed decision making. The commitment of these women to the scientific process and to partnering with scientists in future studies was clear and very much appreciated by committee members. Although the committee's mandate focuses primarily on peer-reviewed scientific evidence, the contributions of women with breast implants provided an extremely valuable context for its deliberations.

History of Cosmetic Breast Surgery

To varying degrees, people are concerned about the appearance of their bodies, and cosmetic surgery is a response to such concern. In a recent discussion of this, Sarwer et al. (1998a) noted that 34% of U.S. women were dissatisfied with their breasts, and more than half of breast augmentation patients reported having frequently checked the appearance of their breasts and camouflaging them. The literature also describes surgical interventions and the results of efforts to change natural breast dimensions over at least the past hundred years. Augmentation with modern silicone implants can variably affect the shape and size of the female breast; on average, an increase of two brassiere sizes (cup or cup and chest circumference; circumference increases in 1 inch or 2.5 cm increments) is achieved (Young et al., 1994).,

Reconstruction after mastectomy for cancer, fibrocystic disease, or other reasons such as prevention in women at high risk for breast cancer is believed to provide a sense of having overcome disease (Bard and Sutherland, 1955). Especially when performed soon after mastectomy, breast reconstruction is reported to relieve or prevent a perception of loss, dissatisfaction with an external prosthesis, depression, and feelings of diminished sexual attractiveness (Schain et al., 1985; Stevens et al., 1984).

These powerful motivations may explain the continuing acceptance by many women and health professionals of evolving cosmetic surgical breast procedures despite complications, high incidence of hardness, and often globular or otherwise less than natural-looking breasts.

Autogenous Tissue

The modem history of cosmetic breast surgery began in the late 1800s. It has involved the use of both autogenous tissue (which is not the subject of this report) and alloplastic implants, culminating in the variously filled