Christina Patterson: If bigger breasts are the answer, what's the question?

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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.

Friends, Romans, and fellow narcissists

It would be very hard to match Berlusconi for the title of the silliest leader in Europe and, indeed, for the most unpleasant. A man who makes little cracks about Hitler at youth rallies, while also launching crackdowns on immigrants that look quite a lot like fascism, and who can't stop boasting about his sexual performance and irresistible wealth, will always have a head start. But Nicolas Sarkozy appears to be catching up fast.

We already knew, of course, that the two tiny strutting statesmen shared a penchant for nepotism. We also knew that both men think chucking Roma out of their homes is an excellent way to boost flagging popularity. And now it's beginning to look as if Sarkozy shares his confrere's taste for censorship and complicated political funding.

One might almost, if these weren't among the unlikeliest words in the English language, feel sorry for Carla Bruni. But she, I think, can look after herself. According to a new biography published this week, France's feline first lady maintains an entire tribe of former lovers and even invites them to share her holidays with her husband. She is so neglectful of her charitable work that she is known in the Elysée as the "anti-Diana". And her chief ambition, apparently, is to outshine Michelle Obama.

Heaven knows if any of this is true, (and the Elysée deny it, of course) but the Frenchman, the Italian and the Italian-French femme fatale certainly seem to make up a kind of unHoly Trinity of vanity, narcissism and quite breath-taking self-indulgence.

Thank the Almighty, the end is nigh

This time next week, Deo gratias, it will all be over. No, not the great Papal palaver, and the terrorist plots by Arab fruitcases (thus giving the unfortunate impression that we're a Third-World country) and the accusations of "aggressive secularism", although no atheists have, as far as I know, been planning to blow anyone to pieces, and the scraping-the-barrel compliments about our conduct 70 years ago, but the other one, the one that seems to have been going on since before the Big Bang and which has convinced many of us of the existence of purgatory.

This week, Ed Miliband has been telling anyone who cares to listen that he's "increasingly confident" of victory. Most Labour party supporters don't want him, but the white smoke emanating from the party seems to suggest he might win. I know his mother is keeping out of it (has in fact said she would vote for Diane Abbott), but if I were her, I'd want to say that her younger son's comments were unkind, unnecessary and a very poor show.

c.patterson@independent.co.uk