(WOMENSENEWS)--This summer 17-year-old Aubrie Wills is getting a special graduation present. It's not a new wardrobe, a laptop computer or a trip to Cancun. It's a set of breasts.
"If I go to college, then no one's going to know my boobs were small," said the Grapevine High School senior who endures teasing in suburban Dallas. "It would be a lot more evident if I did it in the middle of the schoolyear."
Her mother, grandmother, two aunts and stepmother have implants. Aubrie, who turns 18 in July, hopes to enhance her 32A cups to a small C. "If my mom is offering to pay for it now, why not?" she said.
Last year, 3,841 women 18 or younger underwent breast augmentation, a 24-percent jump from 3,095 in 2002, which represents a 19-percent increase from 2,596 in 2001, according to the American Society of Plastic Surgeons. Only 978 girls had the procedure in 1992. (Women between 19 and 34 account for a large segment of those getting implants; 114,005 last year.)
More teens visit plastic surgeons this time of year. "You see it around graduation," said Dr. Rod J. Rohrich, the society's president. "You see it around holidays and spring break, especially around the Christmas season."
The phenomenon is taking off across the country, but doctors say implants are especially popular in Texas and California. "Breasts are a fashion item," said Dr. Garry Brody, professor of plastic surgery at the University of Southern California in Los Angeles. "In the 1920s--the flapper era--women were binding their breasts to make them look smaller to suit the fashions."
"When I graduated high school in 1990, the big thing was nose jobs," said Jo Trizila, director of media relations for the Greater Dallas Chamber. Now, 8 of her 10 friends have implants. Those who couldn't afford them took out a loan.
Body Image Trumps Safety
With television shows like "The Swan" showcasing plastic surgery, more teens view breast augmentation as a commonplace procedure.
A 17-year-old who saw Dr. Edward Melmed before graduation "thought it would be a fun thing to do," said the Dallas plastic surgeon, who removes implants and testified before the Food and Drug Administration's advisory panel in October. "They regard it as having your hair done or getting a new watch. She had no concept that this was a serious operation."
"We tell them it's real surgery," said Rohrich, chair of plastic surgery at the University of Texas Southwestern Medical Center at Dallas. "It has real risks."
But for many teens, appearance trumps caution. "Our biggest concern with adolescents is that they may not necessarily appreciate the relative permanence of the changes," said Dr. David Sarwer, a psychologist at the University of Pennsylvania School of Medicine's Center for Human Appearance in Philadelphia. He has gathered anecdotes about "suburbs of big cities where cosmetic surgery is a relatively common Sweet 16 or high school graduation gift."
Dr. Douglas Senderoff of New York, who practices in Manhattan and Westchester County, says minds are often made up before consultations with him begin. Several 17-year-olds inquired about implants, he recalled, including a teen with severe asymmetry. Insurance covered implant surgery for one breast and reshaping the other.
When parents ponied up $7,000 for breast enlargement--a cost that varies depending on location--"they thought it was important for their (child's) well-being," said Senderoff, who turns away girls under 18. "At 16 or 17, you may be very skinny. By 18, you may fill out a little more."
Try telling that to teens who admire full-breasted magazine models. "We get calls from teen-age girls like, 'I'm getting my implants next week. What do I need to know?'" said Diana Zuckerman, a psychologist and president of the Washington-based National Center for Policy Research for Women and Families. "Teen-age girls have the worst body image."
"In the patients I'm treating, it's severe lack of breast tissue," said Dr. Susan Kolb, a plastic surgeon and holistic medicine specialist in Atlanta. "It's not that they have a B and want to go to a C."
Kolb knows how they feel. As a flat-chested 31-year-old Air Force doctor, she decided it was time to change. After surgery in 1985, she experienced a common complication known as capsular contracture--tightening of scar tissue
--around the right implant. Years later, her left implant leaked silicone. She developed fibromyalgia and other immune-related disorders along with neurological disease. In 1997, she traded those implants for smooth saline.
"A lot more research needs to be done on the safety of breast implants," said Kolb, 49, an expert on saline and silicone complications. "There are a lot of unanswered questions in my mind." Risks include surgical complications from anesthesia, excessive bleeding and infection.
Over time implants rupture or deflate, requiring additional surgeries. This can happen immediately, within months, several years or later after the initial procedure. With saline implants, women sense a change more easily. But the thicker silicone-gel implants maintain a better shape, compromising detection of a rupture.
Implants also can make it more difficult for mammography to pinpoint breast cancer. Removing them could result in loss of breast volume, distortion and wrinkling.
To inform teens about the health hazards, Kathy Keithley Johnston visits Missouri's secondary schools. She passes around an implant in health education classes and shows graphic photographs of girls disfigured after implant removal.
"We want to be the primary clearinghouse of information in the U.S. on breast implants," said Johnston, a registered nurse and executive director of Toxic Discovery in Columbia, Mo., which reaches out to high schools and colleges nationwide.
Johnston, who turns 53 this month, remembers being teased as a flat-chested teen. In 1984, she was implanted at no cost in Midland, Texas, as a poster child for a manufacturer's video. She co-founded the advocacy organization in 1995, the year after autoimmune disease compelled her to part with implants. The plastic surgeon had assured her they would last a lifetime. It turned out to be a lifetime of pain and suffering.
Cindy Fuchs-Morrissey underwent a bilateral mastectomy at 35 after three silicone-gel sets to correct a deformity. She got the first set at 18.
"The surgery was a birthday present from my parents," said Fuchs-Morrissey, a 46-year-old mother of three girls in Macon, Mo., who suffers from multiple sclerosis. She believes her 14-year-old daughter Hilary's scleroderma, a systemic sclerosis, is linked to silicone crossing the placental barrier.
In 2000, the Food and Drug Administration approved saline implants for women 18 and older. Its recommendation is only advisory because breast implants, unlike medications, are not regulated by the FDA. Silicone-gel implants are not approved for marketing and are available to women only through FDA-approved clinical studies.
At 19, Kacey Long went from 34B to 34D while yearning to belong to the "ritzy culture" at Baylor University in Waco. This past September, about three years later, she had the implants removed due to excruciating pain and silicone poisoning.
"My best friend's mom worked for my plastic surgeon for 12 years, and she received breast implants six months before me," said Long, now a 22-year-old graduate student in special education at Texas A and M University-Commerce. "She said that in her time at the office, no one ever had any problems. So I really thought that I had inside info and that these devices were completely 'safe' and maintenance-free.
"I am still paying on my augmentation surgery," she added, "even though my breast implants are now at home with me in a jar, where they should have been all along."
Susan Kreimer is a freelance medical writer in New York City.
For more information:
National Center for Policy Research for Women and Families--
Implant Information Project:
Breast Implants: Recovery and Discovery: