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Mover and shaper
By LEONORA LaPETER
TAMPA -- It's 11 a.m. at Tampa Outpatient Surgery, and already Dr. Dan Diaco is well on his way to giving his fourth patient of the day a new silhouette, a new self-image.
He props up the unconscious woman and looks at his work from the end of the cross-shaped operating table.
Then he angles his head, looks at her the way a golfer would line up a putt. And he decides.
"She needs 25 more ccs," Diaco says. "She's going to tell me she's not big enough if I don't."
He turns a valve, allowing more saline liquid to flow first into one side, then the other.
His black Nike sneakers squeak as he moves around the operating table, sewing up the cuts he has made in her armpits. Thirty minutes after his first incision, her surgery is done.
Once barely a 36A, she's now a 36C.
"One of the most frustrating things for me is to figure out the right size," Diaco says. "I don't want to make them too big, but I'm used to them saying afterwards, 'Gosh, I wish you'd made them a little bigger.' So I push them to as big a size as I think is going to look good on her."
Diaco leaves one surgery room and enters another. On the erasable board in the hallway, his name is written six times. Two more women to go.
On Wednesdays, Dan Diaco gives women larger breasts. A new look. Maybe a little power.
Diaco -- avid hunter, boxing enthusiast, a guy with a king's throne in the foyer of his South Tampa home -- is arguably the area's most prolific breast man. He has performed about 1,200 operations in the past 3 1/2 years, 350 in the last calendar year alone.
He's part of a nationwide boom in the breast business.
Ten years after the Food & Drug Administration imposed a moratorium on the use of silicone gel implants because of safety concerns, the number of women getting breast augmentation surgery is exploding again. Now it's mostly saline that is giving women what nature didn't. More than 216,000 had their breasts enlarged last year, up from 32,607 the year after the moratorium.
Diaco is 35 years old, a muscular guy with short, black wavy hair, chiseled features, a $100,000 black Ferrari convertible and a 23-year-old girlfriend (she has implants, but he didn't do them). After only four years in business, he is busy enough to do eight to 10 surgeries in a day.
His breast implants even have a name. Diacos.
Mary Cutini has a pair. The 37-year-old mother of four from Riverview paid for them by collecting change in jars and cashing in a $100 savings bond that her grandmother gave her in 1976.
Misty Ward, a 22-year-old nude dancer who has wanted big breasts since fifth grade, also has them. Though now she's wondering if her 36Cs are big enough. And Marlene Reed, a 53-year-old Clearwater hairdresser, will walk down the aisle as a bride this spring with something new.
They come, one by one, a pilgrimage of sorts.
They tell Diaco their private thoughts, the ones they think every time they look into the mirror. Some have seen their breasts disappear after breast feeding. Others are young and small, and they want to be larger.
The surgery has risks. According to studies by implant makers, 13 to 21 percent of women receiving implants nationwide will need more surgery to fix problems within three years. Another 16 percent will experience breast pain.
And Diaco himself is controversial; he has been criticized for drumming up business with the help of his buddy, radio shock jock Bubba the Love Sponge.
But his patients are looking past all that. They just want breasts they can be proud of.
"You know, there's so many different things people do to their bodies these days," says Rebecca Henry, 21, a bond settlement representative with Raymond James Financial. She says all her friends are getting Diacos.
"We're going to die anyway. We're here a very short time, and, you know, I don't think it's going to kill me."
Breast jobs aren't doing Diaco any harm, either. Sometimes the eight Queen Anne chairs in his office on N Habana Avenue are filled with women ready to pay $5,000 for his namesake implants. Cash, checks, money orders, VISA, Discover, American Express and Mastercard accepted.
It's Wednesday and a nurse is helping Diaco put on his surgical jacket. He is in a pink operating room, his recently scrubbed hands in the air as if he were about to lead a chorus.
Earlier, someone had tossed a large black bag into the operating room. It contains the day's implants, 20 or so sets. Diaco always has one of his assistants bring the bulky bag to the surgery center.
"I don't have room for that thing in my Ferrari," he says. "I hate schlepping around with the implants."
His fifth patient of the day is out cold, her arms loosely tied to the cruciform operating table. The tube that feeds her anesthesia protrudes from her mouth. The air is chilly, freezerlike, odorless. The operating supervisor removes the implant from its box and places it in a clear antibiotic solution in a stainless steel bowl.
A nurse hands Diaco a large needle containing a clear liquid. The patient's breasts barely fill an A cup. Diaco tugs at them and wields the needle, puncturing the skin in several places to deliver local anesthetic. Droplets of blood emerge whenever he removes the needle.
Diaco is so comfortable with his surgical routine that he tells a story even as he gets ready to make an incision in the patient's left armpit.
Back in '94, Diaco says, he arranged for former Bucs owner Hugh Culverhouse to come to Charity Hospital in New Orleans to be treated for lung cancer. Diaco, who was a surgical resident there, was present when Culverhouse had a heart attack.
"I did chest compressions for 30 minutes and finally they had to pull me off him," Diaco recalls. Culverhouse died. End of story.
Diaco sticks his gloved fingers into the 11/2-inch cut in the patient's armpit. He starts separating the muscle from the ribs, grimacing as if he were lifting weights.
"This is the hardest part, getting under the pectorals," he says, looking straight ahead. "They don't teach you what it feels like. You just have to know."
He sticks a balloon dissector, a device that looks like a turkey baster, into the incision. Begins to pump the bulb, sending air into the breast pocket and enlarging it to the size of a large grapefruit.
He removes the dissector and then sticks a cautery tool into the incision and begins to burn the muscle away from the ribs. He has also inserted a horseshoe-shaped metal retractor with a camera on the end that's about the size of a pencil eraser. As he works, he watches his progress on a TV at the end of the operating table, his body angled to the left like he's coaxing a bowling ball down the center of the lane.
Is the surgery challenging anymore?
"This is not a difficult operation for me. I can do it easily," he says. "I think the challenge is living up to some patients' expectations of me. . . . They've heard from one patient or another, 'Oh, he's so great.' "
He rolls up the empty implant like a cigar, inserts it into the hole in the armpit. Smooths it out. Pulls a valve attached to it out of the hole, starts filling it with saline from an IV bag.
The woman's breast rises like a muffin in an oven.
Three years ago, Bubba the Love Sponge saw a woman with Diacos and declared them -- on live radio -- "one of the best pair he'd ever seen."
Diaco called Bubba, they got together, became friends. Later Bubba paid $3,000 for Diaco to give his girlfriend implants. She broke up with him, and Bubba wrote a song: Take the Diacos and Run. He played it on his station, 98 Rock.
Then came the 12 Boobs of Christmas.
For the last two years, Bubba has offered free breast implants to six women at Christmastime. Diaco selects the women and does the surgeries. The radio station pays for them. Five hundred women participated last year.
"We took pictures of them topless," Bubba says. "Then we took the Polaroids to Dr. Diaco and asked him, in his medical opinion, who needs boobs the most."
Someone complained to the American Board of Plastic Surgery. Board-certified plastic surgeons are not allowed to participate in contests. Period.
"Soliciting patients through a contest is unethical," says Dr. James L. Baker Jr., a past president of the American Society of Plastic Surgeons and an Orlando plastic surgeon who performs three or four breast augmentations a week. "Some patients he picks may not be the right psychological profile."
"It's not really behavior we like to promote," says Dr. Leonard William Luria, president-elect of the Florida Society of Plastic and Reconstructive Surgeons. He's also chairman of the 22-person plastic surgery department that includes Diaco at St. Joseph's Hospital in Tampa. "It doesn't make the profession look like a profession."
But Diaco, who says he received $1,083 a patient from the radio station to perform the surgeries, says he operates only on women who qualify. He wants to do the contest again next Christmas.
"I don't think I did anything unethical," says Diaco, who has been sued only once in his career, paying $75,000 to a woman for burning her breast slightly with what he says was a faulty cautery tool.
"I'm not giving away a door prize boob job. I'm selecting who the best candidate is. I'm controlling every aspect of it and making every decision."
Bubba also got Diaco involved with Voyeur Dorm, the Webcast that shows half a dozen college-age women frolicking half-nude in a house in Brandon. Diaco performed surgery on Ashley West, 21, at an outpatient surgery center; the operation was then broadcast on the site to fee-paying visitors. Voyeur Dorm paid.
"I did it because I wanted good, well-produced video of my surgery," he says. Prospective patients can see it on his site.
But other doctors questioned his judgment.
"At least he didn't do it on the kitchen table," says Baker, the Orlando plastic surgeon. "That's really a lot of self-promotion, going on a Web site and doing it on Voyeur Dorm. . . . We don't want to get down in the gutter to have patients."
Diaco wants to be a respected doctor and a Bubba loyalist at the same time, but it's a wobbly fence to straddle. Bubba has mentioned Diaco on the air countless times, but both men say Diaco has never paid him anything. This month, Diaco went on the air and offered a tax-month special: $1,000 off a set of Diacos for anyone who signed up by April 15.
"I don't get vulgar with him, vulgar in the sense of common," Diaco says. "I try to play doctor when I'm on the radio with him. I'm not Dan, the Italian guy."
On a Friday night in February, a bright spotlight shines down on a red, white and blue boxing ring set up in a conference room at the Hyatt in downtown Tampa. Between the ropes, a couple of fighters are duking it out, sending beads of sweat flying whenever they land a punch.
Diaco, standing in a darkened corner of the room, is in his element here. His family has sponsored 45 fights in the past seven years. His brother Stephen, a local lawyer, is a boxing promoter. His other brother, Jay, also a lawyer, is the boxing announcer.
And Diaco himself is a cut man, stitching up fighters who spill blood in the ring.
The place is jammed with notables. Yankees owner George Steinbrenner is sitting at a table with comic Jackie Mason. Diaco's father, Joseph Diaco Sr., a surgeon and team doctor for the Bucs and the New York Yankees (when they're in town), is chatting with them. Nearby, former NBA center Matt Geiger is talking into the gold-hooped ear of Bubba the Love Sponge. Before the night is over Diaco will make it a point to schmooze them all.
Between rounds, a young woman in a blue sequin halter and bell-bottom slacks walks up to Diaco, whispers in his ear. She asks if he has been snowboarding in Colorado lately.
She moves on, and Diaco acknowledges that he's "worked on her." And then his hand pans the room, which is filled with muscular men in knit shirts and dress slacks and women in cleavage-exposing halter tops and jeans or slinky evening dresses.
"I could probably round up 20 or 30 women I've worked on in this room," he says.
Diaco is waiting eagerly for the big fight of the night. China Smith's fight. The guy he has helped with strength training, the guy he has a stake in.
Smith is 22 and 0 so far. Diaco and the fighter's handlers are billing Smith as the next great boxer of our time. They're talking with Showtime and HBO about broadcasting future fights. If Smith makes it big, Diaco stands to make lots of money. (Later, on April 19, Smith would suffer his first loss at the Sun Dome.)
On this February night Smith wins again, knocking out a more experienced opponent in just three rounds. The other guy is on his hands and knees, his head down. He shakes his head, puts up his hand. No more.
Diaco lives in a two-story gray Victorian with his 23-year-old girlfriend, Tracy Blake, a student at Hillsborough Community College, and his dog, a Hungarian Vizsla named Duke.
One day in March, Blake gives a visitor a tour of the house. It's close to Easter and she has placed stuffed bunny rabbits, chicks, baskets of eggs and even a little Easter egg tree among the dark, ornate furniture.
But most of the touches in the house are his. Blake points to a framed, artsy photograph of a naked breast in the bathroom.
"I don't think you'd find too many of these in people's houses, but considering he's a plastic surgeon, he can get away with it," she says.
She heads up the stairs, past an 8-foot mahogany king chair in the foyer, the only piece of furniture in the cream-colored entryway. She passes through a guest room with a boat theme to another with a wild-animal theme. A life-sized sarcophagus with the face of Tutankhamen takes up the corner. CDs are stacked inside it. Then she moves through their bedroom with its rococo bed.
The master bathroom has a distinctly different feel, with ceramic angels and candles all over the walls and shelves.
"This is the only part of the house that I got to do really girly," she says. "I probably would have done the whole house in angels if I could have."
Blake, who worked in Diaco's office at one point, is asked whether it is tough having a boyfriend who spends his days with women who have their tops off.
"No, not at all," Blake says. "I think me working in the office, it helped. Dan has the utmost professional way with his patients. I never get jealous."
Diaco himself says he's "a scientist with a conscience."
"It works until you're in the room with a naked girl. Then you have to be professional but approachable. Girls throw me those googly eyes all the time in the office. It makes it real hard. I try to make sure I'm as focused as possible and still be human. I never go into a room without a chaperone either."
Can he still appreciate the female breast?
"It's like a car salesman," he says. "You sell a lot of cars, but you can still appreciate a good one."
He has been engaged several times, but each of the future Mrs. Diacos somehow proved "not to be the right one," he says. He almost married a woman in Texas, but neither one would move and that was that.
As for Blake, his girlfriend of two years?
"It's a stable relationship, and if things continue the way they are, we'll get married in a few years. She doesn't know any more than that. I don't know if we're going to or not going to, but I'm not quite ready to get married yet. She's a very nice person. I love her. We get along very well. She doesn't have a ring."
In another conversation, the subject of commitment ceremonies comes up.
"A commitment ceremony. Can I do that so I can get Tracy off my back for another couple months?" he quips to a co-worker.
Diaco was 5 and living in Georgia when his parents separated and his mother, Arlene Belefonte Diaco, moved to St. Petersburg. His father, a surgeon, later moved to Tampa.
During the divorce a few years later, Mrs. Diaco demanded that her former husband pay for graduate school for all three boys.
"I fought like a crazy woman, and my attorney said, 'Why?' " says Mrs. Diaco, an English teacher at St. Raphael Catholic School on Snell Isle in St. Petersburg. "And I said, 'You never know. Their father went to graduate school, and I want them to have that option.' "
She lived off child support and alimony while Dr. Diaco enjoyed a brick house and a pool on a lake and golf course in Carrollwood.
"We were raised rich every other weekend," says Stephen Diaco, who has opened legal offices in Tampa, Miami and Orlando. "And then we were raised pretty humbly." Today, Stephen runs all of the financial and legal aspects of Dan's business, and Dan often advises Stephen and Jay, a medical malpractice attorney, on their cases.
In school, Dan Diaco excelled academically, earning straight A's from fifth through 12th grades. At Northeast High School in St. Petersburg, he wrestled, ran cross country, was an editor at the school newspaper, a member of the National Honor Society.
"I was afraid not to get A's because I was afraid of disappointing our parents, who were very well-educated," Dan Diaco said. He scored an 800 on his math SAT and was valedictorian of his class in 1984.
He went on to Duke University, where his rebellious side emerged. When someone in a red Z28 stole his radar detector, he tracked the car down a few days later and stole it back. "Only it was the wrong guy," Diaco recalls. Diaco was charged with petty larceny and had to do 40 hours of community service.
He studied medicine at the University of Florida, did his surgery residency in New Orleans, came back to the University of South Florida in Tampa for his plastic surgery residency.
Diaco says he considered becoming an orthopaedic surgeon. But he heard his father complain about HMOs and Medicare and the ever-smaller financial returns he was getting.
So Diaco performs surgeries that aren't covered by most insurance -- liposuction and nose jobs, face lifts and eyelid surgery, and, of course, breast augmentations, which account for 80 percent of his business. He says he made $440,000 last year.
He has even surpassed his father in fame. Once, Diaco Sr. presented his credit card at an auto parts store, and the guy behind the counter asked if he was the breast doctor.
"I said, 'No, that was my son,' and he said, 'Well, just for that, you get an extra 10 percent off,' " Joseph Diaco Sr. recalls. "I've been the chief physician for the Bucs for the past 25 years, and they know my son. It's funny how name recognition is, and he's got it and I don't."
Diaco's mom and dad are proud of him. He and his father are so close that the son stops by the father's office each day and kisses him on the cheek. Still, Diaco Sr. thinks his son spends too much money, doesn't save enough. His mom wonders what else he could have done.
"Boob jobs and Bubba are not what a mother aspires to for her son who is academically gifted," says Arlene Diaco. "But he makes an honest living, he works hard and he's the best. That's where we are today. I have no idea what tomorrow will bring."
Mary Cutini, 37, has large eyes the color of wet sand, high cheekbones and teased short brown hair with highlights. But after she had her fourth child and stopped breastfeeding, she didn't even want her husband to see her naked.
"Which is really sad," she says. "It was pitiful."
The 165 pounds sitting on her 5-foot-2 frame made her feel huge, so she went on a diet and lost 50 pounds, but it didn't help. Her breasts had disappeared. "I couldn't wear anything without a padded bra. All you could see was bones," she says.
She went to Diaco. For some Diacos. It was okay with her husband.
"I know she felt a little self-conscious, and if this was going to please her in the long run," says Dennis Cutini, 39, "I supported her. To me, I think she's beautiful the way she is. But if it's going to help her self-esteem in that area, I support her."
The Cutinis, who live in Riverview, own a video store and a restaurant in a strip mall off I-75 at Sun City Center. But with four kids, including one in braces, money is tight, and Mary Cutini had to dip into the change jar for the surgery.
Six days after her operation, Cutini went in to see Diaco. She was supposed to be massaging the breasts daily, but they were sore, the right side worse than the left.
Diaco examined her and then grabbed her right breast and squeezed it hard, pushing it toward her collarbone. It's called "popping," and he didn't tell her he was going to do it. But it was necessary to make sure the operation properly healed inside.
"I cried for an hour after that, it hurt so bad," she says. "He came back in the room after that, asked me, 'Do you hate me?' I wanted to come over and say, 'Oh, let me come squeeze you like that,' but I knew it was something (he) needed to do."
Now it's two weeks after the surgery, and Cutini is going back to waiting tables at the family restaurant, where she met her husband 12 years ago.
A teenage dishwasher hears she is coming in tonight, and his eyes bulge. It's a look that says, "Britney Spears is on the way."
"Not a word," says waiter Lisa Sumner, 18.
"Not a single word," adds waiter Candy Couture, 31, emphasizing each word as she heads to the entrance to check the specials.
Minutes later, Cutini breezes in. She's wearing an egg-yolk yellow polo shirt, black pants, same as all the other waiters. Beneath the loose shirt, she has a foam strap above her breasts to keep them from rising. It leaves the impression that she is wearing a brace.
Later, some of the waiters are on a break smoking cigarettes, and they ask Cutini if they can touch her. Cutini's ringing up several bills on a calculator, and she's laughing. She and Dennis are by no means stuffy. They even own a Harley Davidson motorcycle. But they're still her breasts. It's not like she picked them up at Wal-Mart for $9.99.
She walks off to give Gordon at Table 19 his bill for the meatloaf special.
"Maybe I'll let them touch them," she says with a grin. "They're curious, but I'm modest and shy."
Seven weeks after the surgery, Cutini says things are different. One day, she was coming out of the shower with a towel around her. Dennis was sitting on the bed. The towel fell and she went to grab it, to cover up.
"And then I thought, 'Wait a minute, I don't have to hide them. And he caught it and said, 'You better not pull it up.' "
Cutini says her husband has even been picking out new shirts for her. "I think he's surprised he likes them as much as he does," she says.
Cutini loves them too. Just one thing.
"I do wish they were a little bigger."
Allyson Beecroft is sitting on a table in one of Diaco's examination rooms. She has a large frame, blond feathery hair that falls below her shoulders, green eyes and a lot of freckles on her tanned face. She does accounting for a petroleum trading company in Tampa.
Her 24-year-old boyfriend, Shane Burke, a Web designer, is sitting in a chair in the corner.
Diaco's assistant has Beecroft put on a small paper vest that opens at her breasts, which are about a size 36C. Her left breast is tattooed with a rose and peace sign; she wants the design removed. And she wants them bigger.
Diaco comes in. His physical therapist is with him. He asks Beecroft how she heard of him.
"Radio," she says.
"How old are you?"
"I'm 27 now, I just had a birthday."
Then she blurts out: "It's warm in your office."
"Well, everyone's got their top off, so if it gets cold then it's really cold."
He rolls up to her on his stool. He pulls open the paper vest, breaks out a measuring tape. Measures from her sternum to the center of her nipple. Then gets the diameter of her nipple. Then the distance from her nipple to the bottom of her breast.
Beecroft is looking at the floor. Her boyfriend is staring at her.
"You want to get augmentation?" he asks. "You have pretty big-sized breasts."
"I want them to be perkier," she says, with a nervous laugh.
"Well, mathematically, your breasts are perky enough."
"I want them more like this," she says, lifting her breasts a little higher and pointing them skyward.
"Okay," he says, "they'll be perkier."
-- Times researcher Caryn Baird contributed to this story. Leonora LaPeter can be reached at 727-893-8640 or firstname.lastname@example.org.
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From the wire