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Teens told no on implants

Pittsburgh's plastic surgeons declining to do breast implants for teen-agers

Sunday, February 11, 2001

By Deborah Mendenhall, Post-Gazette Staff Writer

Last month, teen-ager Jenna Franklin became the controversy du jour in Great Britain when her decision to get breast implants for her 16th birthday hit the tabloids and kicked up indignant moralizing on all sides.

Dr. Simona Paulter, left, and Dr. Lori Cherup at the Cherup center, which performs corrective breast surgery. (Tony Tye, Post-Gazette)

But young Franklin, who proclaimed that "you have to have big breasts to be successful," is not alone.

In the United States, the number of teens who have received breast implants for cosmetic reasons has increased 57 percent between 1996 and 1998, the most recent statistics available.

Even some Pittsburgh adolescents want to go under the knife to get the big breasts that nature denied them.

It doesn't happen here very often, but three top local plastic surgeons say that once a year or so, they find themselves consulting with parents who are willing to pay between $5,000 and $6,500 for an operation that will enlarge their minor daughters' otherwise perfect breasts from a size A cup to a size C cup.

But Pittsburgh plastic surgeons are a conservative bunch, and say they have been turning the parents down.

"I tell them 'no,'" said Dr. Leo McCafferty, a Pittsburgh plastic surgeon and spokesman for the American Society of Aesthetic Plastic Surgery. "I don't want teen-agers to make a lifelong decision that is based on a quest for popularity."

While other local surgeons echoed McCafferty, doctors elsewhere in the nation who are saying "yes" to parents and their teen-age daughters.

In the United States, about 1,840 minors received cosmetic implants in 1998, up from 1,172 in 1996, according to the most recent statistics collected by the American Society of Plastic Surgeons, a professional organization.

And the figure could be even higher.

Those numbers reflect a voluntary survey of doctors who belong to the plastic surgeons' professional society, and who are certified by the American Board of Plastic Surgery.

But doctors don't have to be board-certified to practice cosmetic surgery, which means figures aren't available for the total number of operations performed.

The three local surgeons say if Pittsburgh doctors are performing elective implant surgery on teen-agers, they're keeping it pretty quiet.

"I don't think many Pittsburgh surgeons would operate on B-cup teen-agers who want to look like Victoria's Secret, super-C-cup-plus models," said Dr. Lori Cherup, a plastic surgeon for 11 years. "I'm sure it goes on frequently in California and New York, but not here."

Cherup is board-certified and owner of the Lori Cherup Center for Aesthetic Plastic Surgery in Bethel Park. She believes some cosmetic surgery, such as rhinoplasty, is acceptable for teens.

She also will perform corrective breast surgery for adolescents who have extreme asymmetry, in which one breast is an A cup and the other a C cup, or for amastia, a rare condition in which girls never develop breast tissue.

But she won't operate on a teen-ager who wants to add inches to a small but normal bust line.

"I have had parents come in all distraught because their daughter was distraught at her development relative to all these C-cup girls with Size 4 pants walking around the mall," Cherup said. "But I tell them that this is an operation for a woman. It's not an operation for a child."

How breast implants are done


Risk of complications

Teens are unable to fully understand the concept of complications, she said, and if they do occur, the doctor would be dealing with an immature adolescent and with parents who have their own expectations and issues, Cherup said.

The most common complication is capsular contracture, a tightening of the scar tissue which then squeezes down on the soft implant, causing the breast to feel hard. Other risks include infection, a shifting or wrinkling of the implant which would necessitate additional surgery, and an increase or decrease in the feeling of the nipple or breast.

Most women are able to breast feed after surgery, but that can't be guaranteed because a mother must have feeling in the nipple to nurse. The baby stimulates the nipple, which sends a message to the brain to let down the milk. Without sensation, no signal is sent.

Implants also can make detection of breast cancer more difficult, because mammogram X-rays cannot penetrate the silicone sac.

Currently, only saline-filled silicone shell implants are approved for general use by the U.S Food and Drug Administration, which regulates cosmetic surgery. The FDA hasn't allowed silicone-filled implants since May.

Silicone implants were hotly debated for years after widespread accounts of health problems suffered by women whose implants ruptured or leaked. Women complained of severe scarring, implants adhering to chest walls and damage to their immune systems. Saline, on the other hand, can be harmlessly absorbed by the body in the event of leaks.

The FDA also has approved the implants only for women over 18. An FDA spokesman said, however, that the regulation was a guideline and had no penalty attached. Doctors are free to exercise their judgment and use implants on minors if they wish.

Have they stopped growing?

An added issue teens face that wouldn't affect women is whether their breasts have finished developing. This is important because medical evidence suggests that normal breast development could be inhibited by the consistent pressure on breast tissue, along with scar tissue caused by implants.

In the 23 years he's been a surgeon, Dr. Dennis Hurwitz of Magee-Womens Hospital said, he has never performed cosmetic breast augmentation surgery on a teen-ager and said he never would.

"I won't do it because the motivations of a teen-ager are intense but quixotic and change dramatically over short periods of time," he said. "This is something that will affect them for the rest of their lives.

"It's hard to inform them of what's involved because of their immature approach to life's risks," he said. "Implants are expected to break sometime along the way, but teen-agers have trouble understanding that concept. The are very, very optimistic and tend to gloss over the negative aspects."

But Hurwitz doesn't tell teen-agers they are too immature to make such a decision. Instead, he suggests they come back in six months so he can be certain they have stopped developing.

"And they go and they rarely come back," he said.

Most parents are relieved when their daughters are turned down, while others wait a couple of years and come back when their daughter is a young adult and move ahead with the surgery, Hurwitz said.

In the 10 years he's been in Pittsburgh, McCafferty has turned down about six teen-agers and occasionally has had to dissuade their supportive parents as well.

By nature, he said, teens are idealistic and unrealistic at the same time, and prone to believing that bigger breasts will make them more popular, win them the guy, get them the prize.

"And that will never happen," he said. "If they don't feel good and love themselves, some cosmetic procedure will not do it for them. That sets them up for an emotional disaster."

When he turns them down, McCafferty tries to explain all this.

"I tell them that this is a good procedure, but needs to be weighed carefully when they are older," McCafferty said. "I remind them that their personalities and what is on the inside are much more important than having a large bust."

Bombarded by images

And that is sound advice, according to Beth Venditti, a licensed psychologist with offices in Oakland who specializes in treating adolescents.

It's normal for teen-age girls to feel a certain amount of discontent with their bodies, especially when perfect images bombard them from billboards, the television and teen magazines, she said.

"The standards are very high, perhaps unreasonably high," Venditti said. "But to focus on the breast is microscopic. It's more important for teen-age girls to become comfortable with their bodies and focus on eating well and healthfully, and incorporating exercise."

Parents who think surgery is the cure for teen-age angst are sending the wrong message, she said.

"There are times for medical solutions, but first, people should work on their thoughts, feelings, lifestyle and behaviors and feeling better from the inside out."

And if they are going to work on the outside, there are less dramatic things that can be done to make a person feel more attractive, such as a new haircut or buying some flattering clothes, Venditti said.

The pressure teens feel to be perfect also bothers Marilyn Yalom, senior scholar at Stanford University's Institute for Women and Gender and author of the acclaimed book, "The History of the Breast."

Her book, which examined society's relationship with the breast over history, showed that in Spanish-speaking countries, it was common for 15-year-olds to ask for and be given breast augmentation surgery. But in Brazil, where big breasts were not considered sexy, breast reduction surgery was popular.

Her research also indicated that girls are developing faster and earlier today, which might account for their impatience. Menstruation is common at age 11, 12 or 13 today, compared with 15 or 16 in 1900, Yalom said. "We think it has to do with diet. Nutritionists have written a lot on this."

Whether women and girls will ever be happy with the bodies they were given is an emotionally charged question that causes Yalom to sigh.

"I'm not very optimistic at the present time," she said. "Big-breasted icons do become the model, and this doesn't do anybody any good -- not the child, not the adolescent, not women, not society."

But it does work wonders for the pocketbooks of many companies and medical practitioners.

As popular author Rabbi Harold Kushner has written:

"I have this notion: if tomorrow morning every woman in America woke up feeling good about her appearance, the American economy would collapse."

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