Women are constantly bombarded about their appearance. On any given day, we can be exposed to a plethora of print media advertisements, radio and TV commercials, and on-line ads, all geared to provoke a sale of some essential product or service that will enhance our outer beauty and somehow improve our lives. The implication is always that if we will only use this or that we will be better, brighter, sexier, and by extension, more lovable.

Whatever Mother Nature didn't give us, we can fix through the miracles of modern science - whiter teeth, a clear complexion, beautiful hair, slimmer thighs, and perky perfect breasts. One size too large? No problem - the miracle slimmer can smooth your silhouette. One size too small? No worries! We have the perfect implant to boost your cup size to premium.

When I was a little girl, it never occurred to me to ask God for a certain kind of bosom. I asked him for a whole pile of other things, like curly hair so Mom would stop giving me perms, and to be tall and slim like my sister, but never that.

Maybe I should have started sooner, because when I hit my teens my chest suddenly blossomed into a pair of Marilyn Monroe sized "blanc manges" that woggled when I walked.

No matter what underpinnings I tried, and believe me, we had some pretty fair armor plate back then, nothing held them unmoving in place. In the era of Twiggy, Peggy Lipton, and Carnaby Street duds, having a pair of womanly bosoms was not cool.

Stylish bosoms were high, perky little love-apples. Mine looked like they belonged on someone who should be painted on the side of some WWII bomber, not to some frustrated teeny bopper who was trying to stuff them into a dart-less flat-front skimmer dress.

Many years down the road from that embarrassed girl, I have pretty much stopped comparing my chest to every other woman I see. They are what they are, though I did seriously consider cosmetic surgery for a little "lift and trim", after my son finished nursing.

Was that vanity? Yes!

Consider the case though, of one of my sisters who did have a "boob job", as she calls it. She went to her doctor because of recurring pain.

Her doctor packed her off to a specialist who examined her thoroughly and informed her that the muscles of her chest wall were separating or tearing probably from some kind of repetitive movement, and could no longer support the breast tissue. The muscles needed to be repaired before further tearing occurred,which could make the surgical results far less aesthetically pleasing.

The specialist immediately referred her to a cosmetic surgeon for the repairs, who then, in passing, remarked that it would be no trouble to do a minor cosmetic improvement at the same time, as he would be in the area already, so to speak.

Well, it was a done deal. My sister had never complained about feeling under-endowed, but this was too good an opportunity to miss, she told me afterward. More about her later, though.

One of my in-laws, an extremely well-endowed lady, suffered back pain for years. She used to dread going up and down stairs. With her breast reduction she lost several cup sizes, but her back pain has cleared up and she enjoys walking again.

A dear friend who had a radical mastectomy suffered for years with the indignity of "falsies" as she called them. Being fitted for a swimsuit was a nightmare. She was so worried the breast form would somehow slide out of the pocket in her suit, she finally sewed the pocket shut over the form.

"Natural breast forms, my butt!" she exclaimed in disgust one afternoon. "If I'd have known what it would be like afterward, I would have had them remove the other one, too!"

As there were concerns for her remaining breast, my friend's doctor did not consider her a good candidate for implant surgery. Eventually she did lose the second breast but at this writing is a ten year survivor. She has since thrown out her forms and her padded bras, and is quite comfortable with what she calls her "balanced look".

The option is available to have reconstructive surgery after a mastectomy, but it must be set up and planned for with your doctor before the breast is removed. Nowadays it can be done much more quickly, but still requires careful preparation and your surgeon's agreement.

Is that vanity? Perhaps. Arguably, you are merely replacing what has been removed.

Some of you may remember when silicone implants first became available. They seemed to be too good to be true - a more comparable weight and density, a wonderfully life-like feel... I also remember the horror stories some years later when we added new words to our vocabularies: encapsulation, leaking implant, and capsular contracture.

Encapsulation can happen with either type of implant. The natural breast tissue forms a hard capsule around the implant. This is not necessarily dangerous, but can be quite uncomfortable and unnatural-feeling

Leaking implant can happen with either type of implant. Silicone from the leaking implant can migrate throughout the body causing a variety of symptoms such as decreased breast size, uneven size of breasts, pain or tenderness, tingling, swelling, numbness, burning, changes in sensation, and lumps. Saline leaks cause symptoms such as chest pain, breast rash, and change in size of the breast.

Capsular contracture can happen with either type of implant. Almost every woman with implants has scar tissue surrounding them. This scar capsule is her body’s natural way of protecting her from a foreign object. Sometimes, however, that capsule is too tight and feels like it is squeezing the implant. Symptoms can include pain in the breast, asymmetrical dimpling, breasts looking different from each other, breast feeling too firm or very hard, breasts looking like round balls.

Some women with leaking silicone breast implants must have all their own breast tissue removed because the silicone moved throughout their breast. The resulting mastectomy is not because of cancer but because of silicone.

Most insurance companies will not pay to have a ruptured implant removed, especially if the implants were for non-medical reasons. Patients who received an implant as part of reconstructive surgery have an easier time obtaining insurance coverage for removal of the implants, but they are required to prove the implant is ruptured with an MRI or other test.

So looking at all the expense and possible complications, why would anyone consider having a anything done to her breasts other than a necessary reconstructive procedure?

In a society where we are so valued by our outer appearance, a woman's breasts are a visible symbol not just of her womanhood and nurturing capabilities, but of her desirability as a mate and a sex partner. Anthropology and instinctual, survival-based attractions aside, we are encouraged by media and the example of celebrity to revere physical beauty.

It has been postulated that we select our leaders using far more primal criteria than we might suspect - anthropologically speaking, a tall leader can see over the crowds and the tall grasses, and spot the antelope herds in the distance,

When it comes to standards of physical beauty, however, we have, as a society, set the bar ridiculously high. So few can achieve that artificial level of physical perfection, and it is artificial. If you have ever visited a film or television set and observed how carefully the actors are curried and combed for each shot, or been privy to the meticulous preparation for a single photograph for an advertisement, you have some idea of the extreme unreality of it all.

...and yet we base our expectations of what our appearance should be on this completely ephemeral, artificial construct.

My sister, always an attractive woman, said she finally felt beautiful after her reconstructive surgery. She told me that the boost to her self esteem was amazing, and that she never would have believed it would make such a difference.

That may not be essential, but is it vanity? Really?