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Across all ages and cultures we can find examples of body modification. The first recorded plastic surgery technique was performed as early as 1000 bc, in India, to replace noses that had been amputated as a form of punishment or had literally been bitten off adulterous Hindu wives by their enraged husbands (Favazza, 1996). The Italian surgeon Gaspare Tagliacozzi is often credited as the father of modern plastic surgery. During the sixteenth century, inspired by the need for plastic reconstructive surgery due to frequent duels and street brawls, Tagliacozzi pioneered the Italian method of nasal reconstruction (Gilman, 1999). The origins of cosmetic surgery are therefore to be found in the ‘covering up’ or repair of violent interactions – a dynamic that I will be suggesting is central for understanding some individuals who seek cosmetic surgery. I wish to emphasize ‘some’ because we must beware generalizations: there are no single psychodynamics that can account for the decision to pursue cosmetic surgery in all cases.
In this chapter I will firstly consider cosmetic surgery broadly, but I will focus the clinical example on a patient who sought breast augmentation specifically, because it is not only the most common surgery, but also because it illustrates very clearly some of the dynamics around envy and grievance that, I am suggesting, fuel the pursuit of surgery in some patients, especially those seeking breast augmentation.
My approach here is psychoanalytic and focuses on intrapsychic variables but, of course, the subjective experience of one’s body develops in a given family, in a given culture, and at a particular point in time, that is, the individual body is always also a social body and, importantly, it is a gendered body. The experience of being in a female body will differ from the experience of being in a male body, and this, in turn, will be coloured not only by internal world dynamics, but also by the prevailing cultural projections into the respective f