"We live in a toxic culture," said Donovan Yisrael, community health specialist at Vaden Student Health Clinic, referring to the negative body-image messages delivered to men and women through the media.

Having a negative body image can lead some to over-exercise, but it is becoming increasingly popular nationwide to undergo plastic surgery for a more dramatic change. In 2003 alone, more than 250,000 women underwent breast augmentation surgery, according to the American Society of Plastic Surgeons.

But junior Chethana Kulkarni believes that implants are more than a trend and that societal standards are the primary motivation for women who choose to undergo such surgery.

"The buxom look has always been the classic image of beauty, even during the 90s." Kulkarni said. "Though runway models were very thin, most magazine images and major actresses were still fairly voluptuous women."

While most plastic surgery has been deemed relatively safe, recent controversy has arisen over the decision by a federal advisory panel to allow the commercial sale of previously banned silicon breast implants

According to an April 7 article published in the New York Times, health regulators estimate that up to 93 percent of silicone breast implants "fail" within a decade of surgery.

"Fail" means rupture of the implants in a woman's breast resulting in silicone leakage into the woman's body. Silicone leakage could lead to infection, pain, scarring<\p>--<\p>and in the worst-case scenarios<\p>--<\p>connective-tissue and autoimmune diseases, cancer and lupus.

Silicone-gel implants were first introduced in 1962 as women in the United States were influenced by the allure of the curvy and sensual Marilyn Monroe. At the time, the Food and Drug Administration, or FDA, did not require documented proof that ensured the safety and effectiveness of all medical devices, so the possible complications from silicone-gel implants were unknown.

In 1992, silicone-gel implants were banned in the United States when serious health concerns arose over the breaking and leaking of implants. Several women complained of tissue diseases, including multiple sclerosis, that resulted after their implants ruptured. The FDA restricted the use of these implants to breast cancer patients and those participating in strict research studies.

Women who wished to have cosmetic breast enhancement surgery were left with only one option: saline implants. While saline implants are safer and less expensive than silicone gel implants<\p>--<\p>saline implants cost approximately $400, silicone $800<\p>--<\p>women often refuse saline implants because they feel and look less natural.

Critics of the ban, however, have long contended that the overlooked issue in restricting the number of women who can receive breast implants is self-image. Such critics believe that some women may receive much-needed self-esteem boosts through breast enhancement.

Students here on campus have mixed feelings about plastic surgery<\p>--<\p>including breast implants.

Freshman Kate Vander Ploeg said that she thinks motivation based on social pressure is a key factor for women considering breast enhancement.

"I'm not a supporter of women who go out of their way to impress men by dressing up or trying to change their physical features, but there are different motives for getting breast implants," Vander Ploeg said. "I guess it all depends on who and what you're doing it for."

And on the flip side, Vander Ploeg points out that many women undergo breast reduction surgery for legitimate reasons.

"The stigma that surrounds breast enhancement does not surround breast reduction, even though both are often done for cosmetic reasons," Vander Ploeg said.

Senior Emerson Sykes differentiates between medicine and morality in considering the controversy over breast implants.

"The breast implant culture is kind of sad, but that's my personal opinion," said Sykes. "The ban should be based on medical issues. I know there have been serious problems with implants."

Whether or not silicone implants are very dangerous is still being debated.

A study by the FDA published in the May 2001 Journal of Rheumatology supported the idea that the safety of silicon implants is questionable. According to the study, in which 344 women with silicone-gel implants were questioned about symptoms experienced after breast implantation, women who had experienced ruptures did not report symptoms or illnesses different from women with intact implants.

The FDA also reported that while there was a correlation but not causation between leaking silicone gel and soft tissue syndrome, also known as fibromyalgia. Women who developed fibromyalgia before receiving implants could not be distinguished from women who had a preexisting condition of fibromyalgia. But since the study was a self-report not based on a medical examination, women who completed the report may not have been aware of any problems.

Conflicting evidence caused a nine-member federal advisory panel of plastic surgeons and other experts to overturn the 1992 ban in October 2003. Yet the chairman of the panel later wrote a letter to the FDA asking the administration to reject the panel's overturn. The FDA agreed, ruling that more studies were necessary to test the safety of silicone implants.

But last Wednesday, the same panel voted 7 to 2 to legalize silicone breast implants for women considering cosmetic breast surgery. The vote came as a result of a three-day panel featuring plastic surgery experts and women who had undergone breast enhancement surgery.

While some women offered testimony that their implants broke and leaked silicone into their bodies, causing serious illness, many others testified that implants did nothing but boost their self-confidence.

Because of a lack of findings that linked silicone implants to debilitating disease, the panel recommended to allow California-based Mentor Corporation to offer silicone breast implants to women who wish to undergo surgery for cosmetic reasons. Another company, Inamed, had its petition to sell the implants rejected because the panel found the company's research inadequate.

If the FDA decides to approve the panel's recommendation, many more women may decide to undergo cosmetic breast enhancement. This is an implication that worries many people, including Yisrael.

Yisrael sees the breast implantation culture as a manifestation of distorted body image. Considering the risks associated with silicone breast implants, Yisrael points out that undergoing breast enlargement is similar to eating disorders.

"Overdieting and surgery are drastic means," said Yisrael. "The fact that we do them in the name of beautification is obsessive."

While breast enhancement is not an issue that comes up very often in Yisrael's interaction with Stanford students, he still feels that cosmetic surgery is as much a manifestation of body image issues just as overdieting.

According to the Yisrael, bad body image is a "culturally transmitted disease" that spreads through conversations, language and the media.

"We have bad body image conversations<\p>--<\p>'I'm so fat,' 'I'm so ugly,' " he said. "It's normal, but it's not healthy."