09/18/2010 08:00 am ET | Updated Nov 17, 2011

If Bigger Breasts Are the Answer, What's the Question?

I'm a big fan of plastic surgery. Without it, I think I might feel like a freak. While Voltaire made excellent mileage out of a woman with one buttock, I don't think it would be much fun to be her, or, as I would be without plastic surgery, a woman with just one breast. You could, I suppose, stuff your bra with something round and squashy, but I prefer not to. I prefer to put on a bikini and look relatively normal. I think most of us prefer to look relatively normal.

Operations are, however, horrible. They're painful and unpleasant. The body isn't designed to be whacked with great doses of anaesthetic, and then sliced and diced and stitched. It does its best to deal with it, but it takes its toll. I've had four operations in the past seven years, and I'm extremely grateful for anaesthetics that work and surgeons who know what they're doing. I wouldn't be alive without them. I'm extremely grateful, too, for the plastic surgeon who chopped off half my stomach (though all my friends were offering theirs) and put it in the space just vacated by a breast. But I can't begin to understand how anyone with healthy breasts, or buttocks, or thighs, can take them anywhere near a surgeon's knife for reasons other than medical necessity.

More and more people are. More and more people are, presumably, standing on the escalators on the Tube, thinking "I must get my roots done" or "nice dress, wonder where she got it" and then, seeing one of those posters of a young woman with a pleasant cleavage, and the slogan "Get Ready for Summer" next to the words "Harley Medical Group", thinking "I knew there was something I'd forgotten!" and tapping a number into an iPhone. Or maybe they're nipping out for lunch and grabbing a sandwich and a double macchiato and the cashier's saying, "Would you like some implants with that?", and they're saying, "Oh, go on, then," and next thing you know they're lying on a trolley in a green robe staring at a very big needle.

Maybe some of them do find that larger breasts, or thinner thighs, or a flatter stomach, bring them fame, fortune and tearful interviews with Piers Morgan, or whatever it is they're looking for. But the quest, it seems, is undertaken at some risk. According to a new report by the National Confidential Enquiry into Patient Outcome and Death, a great deal of cosmetic surgery in this country is being carried out by surgeons with little experience or training, in ill-equipped operating theatres, in hospitals that have no consultant or anaesthetist on duty for emergencies, and which offer no psychological assessment or "cooling off" period. Four out of five cosmetic surgery firms were found to be "inadequate", which suggests that patients have a greater chance of ending up on Great Plastic Surgery Disasters, or whatever the latest TV freak show is called, than bagging a pop star or a footballer.

It's dreadful, of course, that there's a whole area of medicine (or pseudo-medicine, or anti-medicine) that isn't properly regulated, and which allows vain, insecure and possibly just not very bright people to subject their bodies to the equivalent of cowboy builders without apparently understanding that a body isn't quite as replaceable as a kitchen. But what's much more alarming is the mass growth of an industry that's not only dangerous but largely unnecessary. It's one thing to want to look relatively normal. If you look like the elephant man, or have breasts the size of boulders, then the quality of your life probably will be enhanced by some deft nips and tucks. But if you're flat as a pancake, get a Wonderbra. If you're paunchy, eat fewer pies. Take it from me, it's a lot less hassle.

When I was 13, I was obsessed with how I looked. I'd dream about clothes, weigh myself daily and spend hours in the bathroom. Like most teenagers, I grew out of it. It's a very big world, and one's own appearance is a very boring part of it. Increasingly, however, I feel as though I live in a country stuck in eternal adolescence. It's a country where women are, more than ever -- more, even, than in Jane Austen's marriage markets -- judged by their looks, and where women over 40 apparently crack a TV screen. It's a country where heels and hemlines are soaring in line with women's desperation, and one where the top career choice for many girls is to be an appendage with an acronym.

In the past five years, demand for cosmetic surgery has more than doubled. According to other studies, not mentioned this week, women who have undergone breast augmentation surgery are more likely to commit suicide than those who haven't. We are not talking happily ever after. And we won't be, while women, and presumably some men, think that the complexities of the universe amount to a question whose answer is bigger breasts.

This week, Lady Gaga wore a dress made out of raw meat. I don't know her music. I don't know anything about her, really, except that her appearance looks, in this case literally, like bloody hard work. But I do know a post-modern joke when I see one, and I know when it both is and isn't funny.