Why we have breasts, what we don’t know about implants, and the future of breastfeeding

Florence Williams provides a fascinating cultural and scientific tour of breasts through time—and what they might face in the future.

On why we have breasts, what we don’t know about implants, and the future of breastfeeding

Photograph by Kim Cook

Updated March 9, 2018

After reading a report about the presence of environmental toxins in breast milk in 2004, American journalist Florence Williams, who’d just had a child at the time, decided to have her own milk tested. She mailed samples to a lab. The results were astounding and unsettling: her toxin levels were exceptionally high. That propelled Williams to embark on an intense search that went well beyond her initial inquiries into the sociological, sexual and medical complexities of this organ. In Breasts: A Natural and Unnatural History, she provides a fascinating cultural and scientific tour of breasts through time—and what they might face in the future.

Q: You start the book by asking why humans have breasts. What did you find out from anthropologists, and how did their theories differ depending on their own sex?

A: It really surprised me that this topic is still so contentious. A lot of male anthropologists love to study the breast and they seem to be easily persuaded that the breast evolved as a sexual signal. But the more feminist [and more often female] anthropologists said it may be that breasts evolved not for men, but for the fitness of women and offspring.

Q: There is a compromise theory: breasts evolved to help women feed babies, and that made men love breasts.

A: Exactly.

Q: What do breasts signal to men?

A: The theory is that breasts are filled with information for potential mates about the fertility status of a woman, her age, how healthy she is: if the woman is young her breasts will be perky, and if she’s older her breasts will sag. I find this theory flawed. A woman’s breasts are biggest and perkiest while she’s pregnant and breastfeeding—and obviously she’s not a good mate at that moment if you’re just interested in your own offspring. And there are plenty of women who, after childbirth, continue to have nice, perky breasts. So breasts are an unreliable signal of age and fertility.

Q: Studies show female waitresses with large breasts get more tips, and busty diners get hit on more often. Is bigger always better?

A: In Western cultures, the studies do bear out that women tend to get more attention if they have bigger breasts. Many men really respond to big breasts. It’s hard to say whether that’s evolutionary driven or whether that’s our culture. Certainly our culture celebrates and is obsessed with big breasts.

Q: In the early days of plastic surgery, there were four sizes of breast implants: small, medium, large and burlesque, and burlesque was considered huge. Now that’s average.

A: For young people today, most of the images they see are of fake breasts. So you have this skewing of what’s considered normal. And that of course does a disservice to natural breasts and to girls who face this pressure to have a certain type, shape and size of breast. In fact, what you see is this normalization of what’s in effect a pornographic breast.

Q: Big breasts were once considered a burden. Today, breast enlargement is the most common cosmetic surgery. Why the U-turn?

A: I think it was a combination of Hollywood glamourizing women’s breasts after the Second World War, and postwar technology. These fabrics developed that enabled bras to have more uplift, so it was easier to make a big, protruding shape. And then came silicone, which was a relatively inert substance, so women had a relatively safe implant material.

Q: But silicone wasn’t invented for breasts.

A: No, silicone was developed by Dow Corning during the Second World War for use as an engine insulator. It insulated the ignition in aircraft, which enabled them to fly all the way from the United States to Europe.

Q: So how did it wind up in breasts?

A: There were drums of this stuff left on a dock in Japan during the American occupation. They went missing, and it turned out that doctors were injecting the silicone into the breasts of Japanese prostitutes to attract American servicemen. After the war, Dow Corning had a whole division that was trying to invent new uses for silicone, and medical silicone became pretty important. In 1961, a Houston doctor was feeling one of these new silicone bags filled with warm blood, and he said, “My, that feels good. That feels like a breast!” He was a plastic surgeon and had been thinking about implant materials. When he felt that, he had a eureka moment.

Q: What other materials were used early on for breast enlargement?

A: People experimented with things like ox cartilage, glass, wood chips. Even a kitchen sponge, but it hardened really quickly.

Q: You visited Houston. You call it the “Ground Zero” of boob jobs. What was that like?

A: It was fascinating. I was able to meet the first woman to get silicone implants, Timmie Jean [who is 80]. She still has her original implants. They’ve been there for 50 years. She says she doesn’t regret having implants, but she also talks about how they’ve hardened and how they have been painful at times. One of them has ruptured.

Q: In the years after Timmie Jean had surgery, there were massive lawsuits over breast implants. What happened?

A: There were so many problems with the first- and second-generation implants. They leaked. A lot of women got infections, and there was a lot of debate about what this meant for their health. The women claimed to have immune-system problems so there were some class-action lawsuits, and that got a lot of press attention, which encouraged more women to join in. Ultimately, it became the largest class-action suit in the history of the United States. But years later no one has ever been able to prove a link between these leaking implants and a particular illness.

Q: Timmie Jean never sued, even when her relatives who’d had breast implants did?

A: She was very loyal to the doctors, and had a good relationship with them.

Q: Before her, breast implants were first tested on an unlikely candidate.

A: There was a dog named Esmerelda who was the first recipient of implants. She was not very happy with her new profile. She chewed them out.

Q: Are implants safe today? Because they are more popular than ever.

A: When I went to Houston, the plastic surgeon’s office told me that implants are now 100 per cent safe. This just is not true. There are still a lot of problems and side effects, such as loss of nipple sensation and problems breastfeeding. The FDA is requiring implants currently on the market be studied, and the studies show that there is a very high rate of re-operation—something like 30 per cent of implants have enough problems that they have to be redone within their first decade. These are problems that women are not informed about. These procedures are sold as consumer products. They have been downplayed as serious medical procedures.

Q: What do we know about how breasts are affected by toxins in the environment?

A: We know that artificial estrogen, as well as estrogen within our bodies, has big effects on how our breasts work. Estrogen and progesterone help determine the timing of puberty, and girls are reaching puberty earlier. In lab animals it looks like the timing of puberty is very clearly affected by the kinds of chemicals they were exposed to. And we also know that chemicals like BPA, which are active estrogen, can affect the development of the breast and gene expression in ways that make the breast tissue more susceptible to breast cancer later.

Q: Why does it matter that breasts are fatty?

A: A lot of the chemicals in our environment are fat-loving. And because our breasts are some of the fattiest tissue we have, they really accumulate these toxins. We know that some of these chemicals reside in our breast tissue for years and years and years.

Q: You and your young daughter attempted an experiment. What did you find out?

A: First we lived as normal North Americans: we used personal care products [such as shampoo, deodorant, toothpaste] that we purchased at the supermarket. We drank soda and ate food out of a can. Then we had our urine tested for [toxic] substances. A month later I went totally detox for three days: I stopped using personal care products, I only ate food that had not touched plastic, which was very hard to do. And we were both able to bring our levels down 50 to 80 per cent. But interestingly, there were some compounds we were not able to bring down. That tells us we really have no idea where we’re getting some of these exposures. That is a shocking feeling because you realize that you really don’t have control over the substances you’re exposed to. And it takes an enormous effort—really an impossible effort—to make a big dent.

Q: Did you make any changes after that experiment or did it feel futile?

A: It did feel futile. I ended up feeling that this really shouldn’t be my problem. The burden should be higher upstream. It should lie with the manufacturers, and we should have incentives to create products with cleaner chemicals. And it lies with our governments and regulatory agencies because clearly our regulatory laws are broken.

Q: You say that the standard breast cancer risk factors—exercise, diet, smoking—are “fairly useless.” How so?

A: I mean that [experts] are not able to attribute a lot of breast cancer risk to these lifestyle factors. And yet women feel so guilty. We are told that we are responsible for our breast cancer risk, and if only we drank less or exercised more we could make a difference. That’s unfortunate because those risk factors amount to very little. Ultimately, there are risk factors that we don’t know about and that are beyond our control. That’s why we need to look much harder for the causes of breast cancer.

Q: You write that breast density is fast emerging as one of the most important risk factors, but that many women can’t define it, let alone say whether they have dense breasts.

A: It turns out that women with dense breast tissue are at much higher risk of getting breast cancer—I think five or six times—and yet women are not told when they get a mammogram whether they have dense breast tissue or not. This is the biggest risk factor after age. It’s huge. There are laws being proposed to require that women are informed of their breast density.

Q: One of the most polarizing breast topics lately in Canada is around self-examination, and whether it’s helpful in catching cancer. What did you find out?

A: The statistics don’t really bear out that it’s helpful. By the time most women find a lump, the cancer has already spread. It doesn’t really seem to save lives. And yet there’s little else that women can do; it seems like taking away one more tool in the tool box. It just doesn’t feel good. What’s useful about breast self-exams is that it encourages women to really get to know their breasts. I didn’t realize this until researching the book, but if you notice tightening or thickening of the skin, those can be factors. So it is useful for women to get to know what their normal breasts look like so they can notice any changes.

Q: How does pregnancy protect a woman from breast cancer, and does age change that?

A: We know that pregnancy for the most part is protective against breast cancer. We don’t know exactly why, but one theory is that it shuts down the fluctuation of hormones. We also know that pregnancy is only protective in women who have children before age 30. And weirdly, women who have children after 35 are more likely to get breast cancer than women who have never had children.

Q: What are scientists hoping to offer young women so they can benefit from pregnancy hormones without having children?

A: They’re considering giving women a pregnancy-mimicking boost of hormones. It’s very radical, and it has a lot of critics. We won’t see it any time soon. But someday women might take a pregnancy pill to offset the fact that they are having children later. We’ll trick our breasts into thinking we’re pregnant.

Q: Breastfeeding is being promoted today more than ever. And yet the rates in many countries are low, or women don’t breastfeed for as long as is recommended. Why?

A: Breastfeeding is technically hard and it’s incredibly time-consuming. So in countries such as the U.S. where there aren’t generous maternal-leave policies, women have to go back to work, so it’s challenging to keep breastfeeding.

Q: As breasts have become more and more sexualized, how has this affected breastfeeding?

A: There’s a lot of pressure on women to keep their breasts as sexual objects. That’s why this debate on evolution really matters, because it skews how we see breasts. Are breasts for men or are they for infants? It’s hard enough in this culture for women to breastfeed. To [accept] these theories that breasts are for mating or men [makes] it that much harder.

Q: You bring up the issue of breast milk contamination—that the toxins accumulating in a mother’s breasts are passed on to her baby while breastfeeding—and the reluctance among some experts to discuss it openly. Why not?

A: It’s been such a struggle to get women to breastfeed that I think in some quarters there’s a fear that if you talk about the possible contamination of breast milk, we’ll take several steps back. The message they want to be sure to convey is that breast milk is better than formula. There’s a fear of making breastfeeding less attractive than it already is.

Q: Is it still a worthwhile issue to discuss?

A: Absolutely. Breast milk contamination is a canary in the coal mine. It’s another window into the exposures we’re getting. Breast milk is just a lot easier to test than, for example, a placenta or fetal cord blood.

Q: Norway, which has the highest breastfeeding rate in the world, acknowledged that it will reconsider its breastfeeding recommendations in light of breast milk contamination. How significant is that?

A: That’s really significant. My guess is that they won’t change the guidelines, but that they won’t encourage breastfeeding beyond six or 12 months, because the longer you breastfeed the more chemicals you’re giving to your baby. Someday we may get to the point where we say, “maybe we shouldn’t breastfeed for more than six months.” And that would be a really profound and sad moment in modern human history.

Q: Especially given the theory that the whole point of having breasts is to breastfeed.

A: Right. That we’ve compromised this brilliantly evolved organ to the point where it’s not much better than formula.

Q: What do you hope your daughter knows as she grows up that you didn’t about breasts?

A: I hope she grows up with a positive sense of self-esteem. I hope by the time she’s older we’ll have better prevention and detection of breast cancer. I hope she doesn’t develop breasts very early. I tell my kids that breasts are evolutionary miracles and that they are amazingly interesting and important organs, and that they benefited from that.