Under The Same Sun: Be All the C You Can Be

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July 23, 2004

Be All the C You Can Be

The New Yorker is reporting that the Army is offering free breast enlargement and liposuction to soldiers. Meanwhile, the New York Times is reporting that the Army is struggling with recruiting goals and "has been forced to bring more new recruits immediately into the ranks to meet recruiting goals for 2004, instead of allowing them to defer entry until the next accounting year, which starts in October."

Here's the Reuters piece:

NEW YORK (Reuters) - The U.S. Army has long lured recruits with the slogan "Be All You Can Be," but now soldiers and their families can receive plastic surgery, including breast enlargements, on the taxpayers' dime.
The New Yorker magazine reports in its July 26th edition that members of all four branches of the U.S. military can get face-lifts, breast enlargements, liposuction and nose jobs for free -- something the military says helps surgeons practice their skills.

"Anyone wearing a uniform is eligible," Dr. Bob Lyons, chief of plastic surgery at Brooke Army Medical Center in San Antonio told the magazine, which said soldiers needed the approval of their commanding officers to get the time off.

Between 2000 and 2003, military doctors performed 496 breast enlargements and 1,361 liposuction surgeries on soldiers and their dependents, the magazine said.

The magazine quoted an Army spokeswoman as saying, "the surgeons have to have someone to practice on."

Given the lack of significant domestic political opposition to imperial politics, the U.S. elite seems to face challenges only in being able to maintain tools appropriate to the running of an empire. In other words, they face problems internal to their actions and very little from outside forces like the barely alive anti-war movement.

That does not mean that the two problems, the mechanisms of empire and the methods of keeping the domestic population content, are separate. In fact, they are closely linked. The politics necessary to ensure domestic acquiescence create their own difficult problems: it's hard to tell people to continue shopping like there was no tomorrow, remain deadly scared of terrorist attacks, ignore U.S. foreign policy and its effects on the world, and sign up for the military in spite of the growing awareness that you may lose a limb while gaining a steady paycheck.

A difficult tightrope act is necessary to try to keep the messages separate: the poor should join the army and the rest should spend. It's not that simple, though, since a crucial ingredient in maintaining legitimacy for the system rests upon the widespread belief that this is indeed a land of opportunity, that people have a chance to join the upper echelons with some hard work and some luck. By necessity the messages have to overlap.

The army spokesperson says that "the benefit of offering elective cosmetic surgery to soldiers is more for the surgeon than for the patient.... We do it to maintain our skills,” which he added, "are are critical when it comes to doing reconstructive surgery on soldiers who have been wounded."

How do you reconcile the irony here? The main reason military needs plastics surgeons is that wars create many people in need of reconstructive surgery. The fate of the war wounded gets delicate treatment on intellectual mags, yet this society abhors perceived bodily imperfections, let alone major disfigurement. So military personnel who have nothing wrong with them except in comparison to the artificial, unattainable and inhuman standards of a society receive free plastic surgery so that the surgeons can have more practice in putting somewhat back together people whose faces or bodies were blown off.

Of course, as another surgeon replies, some of it are just pure incentive for the enlisted personnel and not at all for the benefit of the surgeons :

Dr. Shaun Parson, a prominent cosmetic surgeon in Arizona, says that cosmetic surgery and reconstructive surgery are two separate specialties. "If the Army is doing breast augmentations," he says, "it's doing it to practice breast augmentations, period."

Here's one of the recipients of free plastic surgery, talking of her despair with her previous looks, sounding straight out of Extreme Makeover:

Janis Garcia, a former lieutenant commander and jag attorney in the Navy, who is married to a retired Navy fighter pilot, says she grew up hating the way she looked. “I wouldn’t even smile in my own wedding pictures.” She checked in to the Naval Medical Center in San Diego for a nose job, a chin realignment, and a jaw reconstruction, free of charge. She also had her teeth straightened. “It changed my appearance drastically, and I became a more confident person,” she said. “It literally changed the direction of my life.” The doctors told her the work she had done would have cost her nearly a hundred thousand dollars.

The numbers are telling. The New Yorker reports that in 2000 and 2003, military doctors "performed four hundred and ninety-six breast enlargements and a thousand three hundred and sixty-one liposuction surgeries on soldiers and their dependents. In the first three months of 2004, it performed sixty breast enhancements and two hundred and thirty-one liposuctions." Meanwhile, Iraq Military Casualty Count website reports that there were 3,331 soldiers wounded seriously enough since April of 2003 that they could not return to duty after seventy-two hours. So it seems like one is much more likely to lose a leg than gain a cup size.

Another mechanism used for cohesion in the military is a curious mixture of "manifest destiny" and "American-supremacy" -- the idea that we as a nation are the best and the brightest, with a unique mission and a special mandate. It's not the same thing as racism, and it cannot be since this is a multiracial country, but it shares characteristics with racism, in particular the idea that others are inferior.

Now, such an ideology is great for maintaining internal cohesion in the army which brings together white rural poor who often grasp at white-supremacy to make up for their disadvantaged station in life with urban black poor and mostly newly immigrant Latinos. Unfortunately for the warmakers, this makes for a very bad ideology for running an occupation because a military held together by its own feelings of superiority while simultaneously drawing its members from the lowest rungs of society cannot treat the natives gently. It simply cannot win hearts and minds when it is subjected to a massive hearts and minds operation by the elite. As a result, we now have an occupation which should have been manageable, at least for a while given that it was replacing the horrific regime of Saddam Hussein, but which has instead turned into a hated regime that most Iraqis want expelled.

Posted by zeynep at July 23, 2004 10:34 AM

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Wouldn't it be great if instead, those doctors "practised" on those who suffer from deformities but can't afford the surgery to correct them. Sigh. Our tax dollars at work.....

Yet we "can't afford" national healthcare...

Posted by: donna at July 24, 2004 12:02 AM

Coming to a recruiter near you soon? - Sex Changes??

Posted by: Ted at July 24, 2004 11:48 AM

I think that we all understand that the reason that the U.S. Army offers free plastic surgery services to its personnel is not so its surgeons can have "someone to practice on," a completely ludicrous rationalization, but rather in order to con and deceive as many indivuduals as possible into remaining in the military, extending their obligation to the government, and then being available to die like dogs when some general in the rear needs another ribbon for his dress uniform. The officers and administrative assistants who run the military's hierarchy of command have virtually no honor, no scruples, and no discipline or morality to behave in a responsible and civil manner.

When I heard that bit of nonsense on the radio about Army surgeons needing someone to practice on, I laughed at anyone stupid enough to believe such a lie, but I also cried for anyone stupid enough to believe such a lie. A con man will always take advantage of someone too weak to understand the con. Unfortunately, the U.S. military's command operations are controlled by way too many con men in uniform. It is impossible to separate the rogues from the victims as they all look alike and wear the same clothes. But it is one, huge, festering, dysfunctional nightmare inside the military branches of this plutocracy. I've been there; I've seen it with my own eyes, and I've felt it with my own person, but I think that it must be even much worse today in 2004 than it was in 1968 when I was discharged from active duty. And it seems that it may only get worse in the near future, regardless of which rich guy gets elected on November 2, 2004.

Sincerely,
Old & In The Way

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Posted by: Casino Games at March 18, 2005 01:39 PM

Wow I Guess military members don't pay taxes!!!!
And what if a female military member gets her breast blown off should she just be without? And I guess the women that lose their breast to cancer should too.
You really need to get your facts strait not everyone gets free surgery for no reason.
Have a wonderful day
Mandy

Posted by: Mandy Beasley at February 3, 2006 01:03 AM

National report--Plastic surgery has a long and storied relationship with the U.S. armed forces. In fact, as Cosmetic Surgery Times reported in October 2003, plastic surgery as a specialty emerged out of the horrors of World War I. Now, in an ironic twist, the very institution that spawned the specialty and was essentially responsible for creating the demand for more and better techniques finds itself defending its provision for cosmetic surgery benefits.

The U.S. Department of Defense found itself on the defensive recently when an article in The New Yorker reported that all U.S. military personnel, as well as their dependents, are eligible for free cosmetic surgery. The article fueled a firestorm of media coverage that questioned whether the "perk" was being used to recruit servicemen and women, as well as whether providing free cosmetic surgery to military personnel on the taxpayers' dime is prudent.

More to the story

It turns out that although it's true that active duty personnel may seek cosmetic surgery--which, along with all other military health benefits, is free--the surgeon must first get approval from the prospective patient's commanding officer, which reportedly is neither easy to obtain nor frequently granted. Furthermore, the surgery isn't free to dependents or to retired military personnel. While the cost to dependents and retirees is described as "nominal" in some places--such as on the Web site for the Facial Plastic Surgery Clinic at Walter Reed Army Medical Center, Washington, D.C.--nonetheless, there is a fee. And everyone eligible for this benefit, including active duty personnel, pays out of pocket for the implants used in solely cosmetic surgeries.

The DOD's defense

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Patricia A. Buss, M.D., a plastic surgeon and a captain in the Navy Medical Corps as well as deputy chief medical officer of the DOD's TriCare Management Activity, explains that the cosmetic surgery "perk" is actually for the surgeons--not the patients--and that prohibiting plastic surgeons from exercising the full range of their skills would make it difficult, if not impossible, to retain these surgeons in the military.

"We need to have plastic surgeons in the military, because we take care of soldiers, sailors, airmen and Marines who are injured and who have things like facial fractures, burns, chronic wounds and skin cancers," she says. "We also use our plastic surgeons to take care of people who have breast cancer, dog bites, cleft lip and so many other things. If we want to keep a cadre of well-trained plastic surgeons wearing uniforms and serving their country, we need to allow them to practice the full scope of care that comes within plastic surgery."

Similarly, Lt. Col. Joseph Legan, M.D., the Air Force Medical Service's chief consultant for surgical services, told Air Force Print News Today, "Air Force plastic surgeons, as with other specialists, require hours of education, training and continuous practice to keep their skills within medical standards. Without cosmetic surgery as part of their scope of practice, they would be deprived of experience in a fundamental part of their field."

Legan adds that the majority of cosmetic surgeries are done in conjunction with the training of surgical residents.

"This not only teaches skills but is a necessary part of training well-rounded surgeons who are every bit as good as their civilian counterparts in all aspects of their respective surgical specialty," he adds.

Cosmetic surgery is done on a space-available basis in the Air Force as well as in the other branches of the military, and, according to Legan, may constitute no more than 10 percent of an Air Force plastic surgeon's workload.

In the Navy Newsstand, Ellen Mauer of the Bureau of Medicine and Surgery Public Affairs reported that the Navy's plastic surgeons have been especially mission-oriented during Operation Iraqi Freedom, performing dozens of reconstructive operations for injured sailors and Marines being treated at facilities such as the National Naval Medical Center in Bethesda, Md.

U.S. Navy Capt. Mark Honig, specialty leader for Plastic and Reconstructive Surgery at the Naval Medical Center in Portsmouth, Va., told the Navy Newsstand, "The Navy (makes) elective cosmetic surgery available to beneficiaries on a not-to-interfere basis, (but it's) primarily to allow Navy surgeons to collect cases for board certification and to maintain their reconstructive surgery skills."

Deja vu defense

This isn't the first time that the military's cosmetic surgery benefit has come under widespread scrutiny. According to Patrick Lappert, M.D., a plastic surgeon and retired Navy captain, the benefit has been tried in the press several times just within the second half of his 24-year naval career.

"This issue comes up every three or four years, and it's typically motivated by one of two things: A private plastic surgeon in the vicinity of a military hospital gets upset that he may be losing business to the (military) hospital and (complains) to his Congressman, or a politician in search of an issue grabs hold of this around election time and starts talking about the military paying for soldiers to get large breasts."

Several years ago, the military put a stop to solely elective cosmetic surgery, and negative repercussions followed.

"There was a two-year period from around 1990 to 1992 that followed another (bout) of publicity when cosmetic surgery was prohibited in the military," Dr. Buss says. "The elimination of cosmetic surgery resulted in several problems. It hurt our ability to train residents, and our plastic surgery, residency programs were suffering. There were negative ratings for plastic surgery and ear-nose-throat (ENT) residency programs because the trainees were not learning how to do cosmetic surgery, and there were problems with trained surgeons being able to take their board certification exams because they didn't have enough cases. It's difficult to retain these people in the military, if you take away a large part of their practice."

Once it became clear that the military had to permit at least some cosmetic surgery to keep residency programs alive and to retain plastic and reconstructive surgeons, the DOD set up a formula dictating the numbers of procedures that could be performed based on a university practice model. The DOD allows surgeons to do a small number of cosmetic surgeries per year so that they can maintain their skills and be competitive with their peers when their term of service is complete. Dr. Buss estimates that less than 1 percent of surgeries performed annually in military hospitals are solely elective cosmetic procedures, and of those, Lappert points out, the majority are for retirees or dependents.

"Active duty service members have a military obligation. To get the active duty service member to the OR you have to get permission from his commanding officer, and the commanding officer is going to want to know why you have to do it and why they should give up the services of this service member," Dr. Lappert says.

Ultimately, Dr. Buss says, if cosmetic surgery were prohibited in the military, recruiting or retaining (plastic surgeons) would be extremely difficult. "What would they look forward to when they finally left the service? They'd have had maybe a 20-year career in the military and hadn't performed any of the operations that their peers are doing," he says.

Dr. Lappert points out that retaining combat specialty surgeons such as plastic surgeons, general surgeons, ENT surgeons, orthopedists and anesthesiologists is particularly crucial.

"Plastic surgeons are pretty much at the top of the list of combat specialists, because in them you get a general surgeon, a reconstructive surgeon and sometimes an ENT surgeon. They know all about trauma management, and in this era of body armor, soldiers will either have a facial injury or extremity injury, so plastic surgeons are the go-to guys most of the time," he says. "When you get a plastic surgeon you've got a surgeon who can triage, who can resuscitate, who can recover soldiers as they're coming in, and while he's there he can start the process of the reconstruction, if not do the entire reconstruction himself."

This, he explains, is why plastic surgeons are "desperately" needed in the military.

In response to news media questions about the use of taxpayer funds to cover elective cosmetic surgery, Dr. Buss defends the benefit. "It is a prudent use of taxpayer money because it keeps our surgeons' skills maintained, and it allows us to retain plastic surgeons, ENT surgeons and ophthalmologists in the military who might not otherwise give us a chance," he says.

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Posted by: Mandy Beasley at February 3, 2006 02:26 AM

Under The Same Sun

reflections on a world where the sun never sets

July 23, 2004

Be All the C You Can Be

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