PARIS - Annick was 22 when she got breast implants. "My chest was completely flat and I'd had a major complex since I was 14. It was really hard, especially with all of my friends wearing bras," says the 44-year-old.

Annick used to hide her lack of breasts by wearing loose-fitting clothes. She even tried to cover her chest by letting her hair grow very long. "I didn't do this surgery to look like a bimbo, I did it to blend in," she says. "To all the people who think this is a frivolous procedure, I say they're really mistaken."

Hostile reactions to breast enlargement (as opposed to reconstructive surgery) have been amplified amidst the unfolding scandal of the defective breast implants produced by the French firm Poly Implant Prothese (PIP). But the caricature of all such cosmetic breast surgery recipients as silicone-enhanced Barbie dolls is simply wrong, insists cosmetic surgeon Jean-Claude Dardour. The vast majority of surgery requests are "healthy," he insists.

Such requests usually fall within three categories: women who have very large breasts and want reduction surgery, those who get implants because they have small or no breasts, and those who get implants because their breasts are damaged or "emptied" by pregnancies or age.

The bigger the better?

Aesthetic norms have changed and large breasts are fashionable. The big breast fantasy began with U.S. soldiers and Jane Russell during World War II. Later, TV shows like Baywatch – starring buxom Pamela Anderson – helped make 34D-sized breasts a trend, at least in the United States.

"At the beginning of plastic surgery, patients were women in their 30s coming with their husbands because their breasts had lost volume after having kids," says Dr. Julien Glicenstein, the former president of the French reconstructive and plastic surgery society. "Then, with the influence of TV shows and magazines, younger women with small breasts started asking for surgery."

Implant sizes in France have grown over the past 30 years, though they're still far from those common in the United States or Latin America. They're usually "reasonable" requests (B or C cups), according to surgeons. That was the case for Hannane, who wanted to get rid of her small breasts. "I was often called Olive Oil, Popeye's wife. After thinking it over for years, I went for it. I want to rebalance my body but I didn't want huge breasts. I just wanted to feel more feminine."

Some women do ask for sizes that surgeons consider over the top. Stephanie got implants when she was 22 – not because she was bothered by her small breasts, but because she believed "beautiful women have curves." She fought with her surgeon to get implants that were bigger than the ones he advised. She went from an A cup to a D cup but still thought her breasts weren't big enough. In the end, 11 years after her surgery, Stephanie is happy with the result.

"I feel more feminine and I have better self-esteem. The only problem is that I've lost all sensitivity in my breasts," she says.

That's a common side-effect, but for "most women, the pleasure of being seen is more important than touch," says Maurice Mimoun, the chief of reconstructive plastic surgery at the Saint Louis hospital in Paris. According to Francoise Millet-Bartoli, a psychiatrist and the author of La Beaute sur mesure (Tailor-made beauty), a lot of breast surgery requests are made by male partners. "Breasts are the symbol of femininity. They have erotic value. Men fantasize about curves," he says.

My mother, myself

For Helene Parat, who wrote Sein de femme, Sein de mere (Woman's Breast, Mother's Breast) many women aren't happy with their breasts. "Plastic surgery requests are just the tip of the iceberg. Breasts symbolize an ideal," she says. "It serves as a base for projection that crystallizes all the disappointments."

According to Parat, a woman's subconscious motivations for getting such surgery are strongly linked to her childhood, to her relationship with her mother, which tends to be the foundation of her femininity.

The image we have of our body is often very subjective because the physical body is different from the imaginary body. There are risks of permanent dissatisfaction, disappointment because of the extraordinary expectations. Sometimes breast surgeries follow a breakup or a destabilizing event. "They attach their problem to one flaw, but what the woman is really looking for is permanent reassurance," says Millet-Bartoli.

Michel Godefroy, a psychiatrist who treats patients sent to him by plastic surgeons, says that women sometimes arrive with pictures of stars. "They want to conform to the image of the ideal woman," he says.

Some fall into the plastic surgery trap, always finding something more to fix. And they always manage to find surgeons with no qualms, willing to answer every last one of their fantasies.

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