by Anu Antony

I am a plastic surgeon, a profession that involves understanding women’s aspirations not only in the corporeal sense, but also being cognizant and mindful of their psyche – the inner thoughts and feelings that drive them to choose plastic surgery.

While choosing plastic surgery can be an empowering undertaking, many women still harbor feelings of guilt. Will their friends and family will think they have succumbed to societal pressure to look a certain way?

Remarkably, many women can feel guilty even when they are getting breast reconstruction surgery after mastectomy. Reconstruction surgery is now widely accepted as a medical treatment for cancer patients – although the breast once removed is not a functional organ like a kidney or liver. I’ve even been told by other medical professionals that I am a “real doctor” because breast reconstruction surgery is my specialty. But a generation ago, even breast cancer patients seeking reconstruction were chastised for seeking procedures that were considered superficial and unnecessary.

Changing attitudes were reflected in 1998 when the Women’s Health and Cancer Rights Act (WHCRA) legalized the right for patients to seek out breast reconstructive services and have those procedures covered by insurance. Perhaps the fact that insurance provides this coverage as a medical necessity gives many patients comfort they are not seeking superfluous cosmetic procedures.

But women seeking other kinds of plastic surgery often still don’t receive the same empathy that my breast reconstruction patients receive. I am wondering if we can broaden this conversation. Might plastic surgery become a right for women to choose?

In my conversations with patients, I hear patients express their desires. Some wish to restore that which cancer took away. Some want to defy their genetics. Others want to undo the effects of pregnancy on their body. I have yet to hear a woman say she is acquiescing to a societal demand for perfection.

To take the “defy genetics” notion a step further, consider gender confirmation surgery. Kaitlin Jenner and others like her have highlighted the plastic surgery procedures they have undergone to live as transgender females. Surely, an understanding of “the why” of a transgender woman is complex, but in a more conceptual sense might be ascribed to an assimilation of their internal conflict with their external selves. This driving pressure to physically change comes from within rather than an external pressure from society to become a woman.

To be sure, as plastic surgeons, we must balance expectation with reality, and the delivery of surgical procedures is as much of an art as is understanding our patients. If exercised judiciously, plastic surgery is intended to improve the quality of life for patients – it is not intended to win the battle of aging or establish cultural norms.

Choosing plastic surgery may not necessarily be an internalization of societal values, but rather stem from agency of the individual. In social science, agency is the capacity of individuals to act independently and to make their own free choices. Thus, the stigmatized interpretation that individuals seeking plastic surgery have internalized societal pressure may be inaccurate. Instead, we may consider another construct inclusive of authenticity of the individual and comprehend that the reasons why women choose plastic surgery most often lie within.

Even for breast reconstruction surgery, the research has borne out that restoration of the breast means the restoration of psychological well-being, not the restoration of the ability to breast feed. Agency in this forum and a woman’s right to choose breast reconstruction surgery post-mastectomy might be considered the direct result of one’s inner Freudian id seeking to restore its psychological self.

Those opposed to aesthetic plastic surgery might consider a nature versus nurture argument. Must we choose to embrace our genetics or do have the power to decide who we are? Perhaps we can remove some of the guilt and understand that plastic surgery can be a source of empowerment whether to treat a congenital birth defect, acne scars of youth, disproportionate breasts, or a tendency to retain weight in certain areas. Can we remove the blame and the unconscious shaming of individuals and understand the decision to choose plastic surgery through a different lens? This is a historical time in the US, where there is a lot of intolerance. However, we are a country founded on choice.

The crux of the feminist movement centers around having equal rights and opportunities – having choice. Being a plastic surgeon has allowed me the opportunity to give women choice: the right to choose who we are in society, have control of our bodies, and what we look like in the world. While some of my most satisfying work to date has been in reconstructing women after breast cancer, I would like to take a moment to encourage tolerance for all. Each of us is on a different path and while we may not all choose the same journey – we can choose understanding.

Anuja (Anu) Antony, MD, MPH, MBA, FACS is a Professor and Vice Chair of the Department of Surgery and Chief of Breast Reconstruction and Medical Director of the Division of Plastic and Reconstructive Surgery at Rush University. Dr. Antony is a Public Voices Fellow with the Op-Ed project and an accomplished writer, researcher, and speaker who lectures nationally and internationally about plastic and reconstructive surgery.