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UvA-DARE (Digital Academic Repository) Breast surgery: A problem of beauty or health? Benditte-Klepetko, H.C. Publication date 2014 Document Version Final published version Link to publication Citation for published version (APA): Benditte-Klepetko, H. C. (2014). Breast surgery: A problem of beauty or health?. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:24 Sep 2021 Breast Surgery Breast Breast Surgery A Problem of Beauty or Health? A Problem of Beauty or Health? A Problem Heike Benditte-Klepetko Heike Benditte-Klepetko Heike Breast Surgery – A Problem of Beauty or Health? Heike Benditte-Klepetko This thesis was financially supported by the University of Amsterdam. Benditte-Klepetko, Heike Christina Breast Surgery – A Problem of Beauty or Health? Thesis Universiteit van Amsterdam – with summary in Dutch ISBN: 978-94-6169-518-5 Layout: Optima Grafische Communicatie, Rotterdam, The Netherlands Printed by Optima Grafische Communicatie, Rotterdam, The Netherlands Cover: Nana, Niki de Saint Phalle (1930–2002) Copyright: H.C. Benditte-Klepetko, 2014 No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior admission of the author. Breast Surgery A Problem of Beauty or Health? ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus Prof. Mr. H.M. de Jong ten overstaan van een door het college voor promoties ingestelde commissie, in het openbaar te verdedigen in de Aula der Universiteit op 21 Mei 2014 door Heike Christina Benditte-Klepetko geboren te Langenhagen, Duitsland Promotiecommissie promotores: Prof. Dr. C.M.A.M. van der Horst Prof. Dr. M. Deutinger overige leden: Prof. Dr. M. Maas Prof. Dr. J.C.J.M. de Haes Prof. Dr. J.H.G. Klinkenbijl Dr. L.A.E. Woerdeman Dr. H.A.H. Winters Faculteit Geneeskunde Aan mijn kinderen Contents Chapter I Introduction and aim of this thesis 9 Chapter II Hypertrophy of the breast: a problem of beauty or 37 health? Chapter III Crucial aspects of smoking and wound healing 51 Chapter IV Psychosocial aspects in breast surgery 63 Chapter V Functional and ultrasound evaluation of donor site 77 morbidity after TRAM-flap for breast reconstruction Chapter VI Patient satisfaction after different techniques of breast 91 reconstruction Chapter VII Correlation between MRI results and intraoperative 105 findings in silicone breast implants: the role of the linguine sign Chapter VIII General discussion and conclusions 119 Chapter IX Summary 129 Chapter X Samenvatting in het Nederlands 135 Acknowledgment 141 Curriculum Vitae 145 Chapter I Introduction and aims of this thesis Introduction and aims of this thesis 11 Introduction The female breast in culture and art Throughout the ages, the female body has been revered as a work of art and beauty and as a source of life, from which all people are born. The breast is one of the most predominant features of a woman and stands out as a symbol of womanliness and livelihood1. The way how the breast is viewed throughout history is a direct reflection of the views of women of time and life. In European pre-historic societies, sculptures of female figures with pronounced or highly exaggerated breasts were common, symbolising fruitfulness and nourishment. A typical example is the so called Venus of Willendorf2, one of many Paleolithic Venus figurines with ample hips and bosom (fig.1). Artefacts such as bowls, rock carvings and sacred statues with breasts have been recorded from 15,000 BC up to late antiquity all across Europe, North Africa and the Middle East. In Ancient Greece there were several cults worshipping the “Kourotrophus”3, the sucking mother, represented by goddesses such as Hera and Artemis. Neverthe- less, the worship of deities symbolised by the female breast in Greece became less common during the first millennium. Classic Greek society praised masculinity and repressed femininity. Woman in art were covered or portrayed in postures that were intended to express shyness or modesty4. A popular legend at the time was that of the Amazons, a tribe of fierce female warriors who socialised with men only for procreation and even removed one breast to become better warriors (the Figure 1: Venus of Willendorf 12 Chapter I idea being that the right breast would interfere with the operation of a bow and arrow)5. With the rise of Christianity, the breasts and the flesh in general were discouraged from being exposed. Medieval Christian stories focus on the breast milk of the Virgin Mary as being the most holy and miraculous of fluids4. It was not until the fourteenth century and the Renaissance that this began to change. As people became more frivolous, clothing became more revealing, and the neckline lowered to show cleavage6. In the seventeenth century, the breast once again became the predominant center of female attractiveness, being a symbol of power and wealth6. After the French Revolution an outpour of emotional awaking occurred and inde- pendence and freedom of expression lead to a decade of naturalism where breasts became symbols for emotion and naturalism4. This symbolism is well documented in the famous painting of Eugene Delacroix (“La Liberte guidant le peuple” from 1830), in which “Liberty” is symbolised by a bare-breasted robust woman holding the “La Tricolore” (fig 2)7. When this Romanticism calmed down the proper display of the breasts and waists through corsets became an important part of fashion society4. Nevertheless, due Figure 2: “La Liberte guidant le people”, Eugene Delacroix 1830 Introduction and aims of this thesis 13 to the physical restrictions of women by corsets, there was a growing opposition to this phenomenon at the turn of the century. During World War I women’s roles in the work force increased. In 1919 women acquired the right to vote in the United States and there was a growing belief that women were able to do almost anything a man could do. Therefore breasts as a sign of femininity were bided down to emphasise the less gender based roles in the society4. After the chaos of World War II, people again looked for stability and fertility. Therefore the female breasts once again became popular as a symbol for prosperity. During the rise of motion pictures big breasts were viewed as symbol of sexuality in contrast to small breasts, which were associated with upper class sophistication and wit. Based on this a period of rebellion started in the 1960’s and 70’s. One of the best- known aspects of the early Women’s Liberation Movement those days was the “bra burning”8, a form of liberation to make men face up to the reality of the breast by freeing it from it’s fantasy underpinnings. This symbolic act was meant as a serious criticism of the modern beauty culture, of valuing women for their looks instead of their whole self. When the hippie era calmed down, perfection of the body became an ideal, which was reflected by its frequent use in advertising. Large breasts came back in fashion and woman started to use breast implants to enlarge their breasts6. Nowadays large breasts emphasise gender differences, femininity and womanhood, reflected by a constantly increasing of number of aesthetic breast surgeries. Meaning of the breast As history reflects, the cultural significance of the breast revolves around its use as a symbol both of fertility and sexual pleasure. Many women regard breasts as an important female secondary sex characteristics, and a factor in the sexual at- tractiveness of a woman9. For Freud, the breast was the first erogenous zone, from which a child should move on to the anal and genital stages of it’s developing sexuality. The baby’s complete satisfaction at it’s mother’s breast led to an identification with the mother, after which the baby needed to develop a sense of itself as a separate being. In adult life, a person therefore longs for the perfect pleasure of the breast, which has been taken away10. Beside this analytic point of view, the media is obsessed with portraying the “perfect body”: being thin and having perfectly shaped breasts. Women seeking to 14 Chapter I reach this ideal are at risk of feeling uncomfortable to the extend of suffering from low self esteem and therefore disturbed body image. This might induce an impair- ment in psychological well being, social life and disturbed relationships resulting in a decreased quality of life11. Disorders of the breast Anomalies 1. Polythelia/Athelia Accessory nipples appear along the natural mammary lines between the axilla and the groin. In contrast in case of athelia the nipples are imperfect or incompletely developed. This developmental breast abnormality affects slightly less than 2% of women and less than 1% of men around the world.

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