Cleavage: Technology, Controversy, and the Ironies of the Man-Made Breast (review)

Cleavage: Technology, Controversy, and the Ironies of the Man-Made Breast. By Nora Jacobson. New Brunswick, N.J.: Rutgers University Press, 2000. Pp. viii+302. $52/$20.

Glass balls, paraffin, olive oil, Teflon, silicon, nylon, Plexiglas--the stunning range of substances inserted into women's breasts over the past hundred years evokes the wide history of human innovation. For that reason alone, historians of technology will find much of interest in Nora Jacobson's thorough, detailed study of breast implants. A helpful addition to a growing literature on medical and cosmetic technologies, Jacobson's book confirms that substances and devices developed for use in the human body provide a useful lens through which scholars can apprehend larger technological trends.

Cleavage, however, declines lenses and vision as guiding metaphors for scholarly investigation. Rather, the study employs a theme of touch; as Jacobson points out, the book's chapters advance like a breast self-examination, moving slowly outward, in "ever widening circles," from the breast implant itself (p. 249). From an engaging (if gory) exploration of techniques of breast removal, augmentation, and reconstruction, the study pushes and presses larger sociological questions: the development of a perceived "need" for breast implants, the emergence of the concept of harm from implants, and the movements of major players in the implant debates of the late 1980s and early 1990s.

Jacobson, a medical sociologist, probes these questions using a constructionist approach adapted from mainstream sociology (rather than from the SCOT literature more familiar to readers of this journal). Like most works of social constructionism, the book focuses--as its title implies--on controversy. A century after a surgeon first transposed a lump of fat cells from a patient's flank to the crevice in her chest, massive cleavage over the use of breast implants persists among plastic surgeons, government regulatory agencies, manufacturers of implants, and the millions of women in whom these devices are embedded.

The ambivalent position of these women--at once users, consumers, and patients--directs the scope and character of the book. Like any consideration of seemingly superfluous and potentially dangerous technologies (cigarettes, tanning beds, Viagra), the relationship between artifact and actor provokes a set of obvious questions. Are technologies such as breast implants empowering or debilitating? Are users of such technologies passive dupes or reasonable, autonomous agents? Do the debilitating results of these technologies demand individual or social accountability?

One of the greatest strengths of Cleavage is its refusal to reproduce these stale debates. As Jacobson aptly notes, questions that focus on individuals' concessions to (or rejections of) social pressure tend to overemphasize personal choice, to conceptualize "society" only in the most loose and encompassing terms, and to erase the historical specificity of particular technologies. Jacobson proposes to mend such analytical shortcomings (and to sidestep the inherent paradoxes of "choice") by resituating breast implants in their particular circumstances, exploring "the ways in which the technology shaped and was shaped by different groups and institutions" (p. 5).

Debate over implants, in other words, must not be approached as an abstract contest between women's self-empowerment or social conformity, but rather as a question of specific meanings. Thus, the book charts the contradictory meanings of breast implant technology advanced by surgeons, activists, manufacturers, journalists, lawyers, and others. As Jacobson summarizes in an epilogue, "The problem of implants is a problem of clashing meanings. The solution lies not in the science of epidemiological research but in the trans-science of ideology" (p. 251).

This focus on complex, contradictory meaning, which resonates with several other recent studies of technology, allows the author to weave together an impressive collection of disparate sources, including popular women's magazines, trade publications, Food and Drug Administration transcripts, legal documents, letters, and medical reports. Moreover, Cleavage extends a growing body of scholarly literature on "cosmetic" sciences and technologies, and its careful elucidation of the meanings of breast implants will be useful to researchers...