Negotiating present and future selves Women's decision-making to pursue breast augmentation surgery on the NHS

A material-discursive framework was used in this qualitative study of eight women's
decision-making for breast augmentation surgery on the NHS, using pre-surgery
interviews. The NHS offers cosmetic breast augmentation surgery in "exceptional
circumstances". An interpretative phenomenological analysis was carried out to
consider how women conceptualised the process of deciding to pursue this surgery,
which included their reasons for pursuing surgery and their perceptions of the risks
involved. The women described how they viewed their breasts as "abnormal" and
"unfeminine", which impacted on how they perceived themselves. The consequent
distress led them to seek breast augmentation surgery, which they anticipated would
lessen their distress and produce positive feelings. The women also explained how the
anticipated changes rendered the medical and psychosocial risks negligible. The
women's accounts of their decision to have breast surgery revealed the dynamic
nature of decision-making, evident through continuing risk-to-benefit appraisals,
ambivalence and the accumulation of supporting evidence. This would indicate that
breast surgery was a satisfactory rather than optimal choice. Subsequently, the
Foucauldian discourse analysis focused on the discursive constructions of 'small
breasts' and 'breast augmentation surgery'. It revealed how discourses which
perpetuate the notions of self-improvement and bodily interventions as acceptable,
positively framed the women's decision to have surgery. The women's construction
of bodily appearance as central to self-identity and self-worth supported their
evaluation of their breasts as making them feel "unfeminine" and their choice of
surgery as a means of producing a feminine identity. The women's perception of
surgery as a process of psychological change suggests that service provision should
involve psychologists. The process of obtaining breast augmentation surgery on the
NHS also reinforces women's perceptions of their breasts as "abnormal". Current
pathways should be reconsidered and it may be helpful for primary care interventions
to promote solutions other than BAS.
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