A Cap and Gown--and New Breasts
Driven by vanity, self-esteem issues and society’s fascination with breasts, teenagers are having implant surgery in increasing numbers, especially in affluent areas of California and other Sunbelt states.
Some high school students have returned from spring break with a new bust line in time for the prom. Others are receiving breast enlargements as graduation gifts from their parents.
Older teenagers are using inheritances, loans or their savings to pay for what nature didn’t provide.
This month a Huntington Beach high school senior--tall, pretty and with a perfect smile--is debating which college to attend. Next month the 18-year-old, who did not want her named used, will spend $5,000 of her savings on the surgery.
“It is to make me feel better about myself,” she said. “If I had a big nose, I would want to fix it.”
Her mother, who had implant surgery more than a decade ago, at age 31, would have helped pay for it.
“If that is what she really wants to do, I am not going to make a war over it,” she said.
Breast augmentation has become the third-most frequent plastic surgery--after rhinoplasty and ear pinning--for girls not yet 19, according to a survey by the American Society of Plastic and Reconstructive Surgeons. In 1998, 1,840 girls under the age of 19 had breast implants, up 57% from 1996 and an 89% increase from 1992, with the greatest number of surgeries being performed in California, Texas and Florida. The actual number may be 50% higher, said experts, because the surgeons group surveys only its 5,000 members, not other physicians who do the procedure.
Teen surgeries remain a tiny fraction of all breast augmentations, but the procedure for adolescents stirs controversy, even among physicians. The nation’s leading plastic surgeon associations have no specific age guidelines for patients receiving implants. Consequently, doctors must use their own judgment to balance benefits to a teen’s ego against psychological, ethical and medical concerns.
A few doctors say they avoid providing cosmetic implants on anyone under 18. Other surgeons are more cautious with prospective teen patients than with older women.
“I have interviewed many 16-year-olds and turned away 95% of them,” said Dr. Michael Niccole, a plastic surgeon with offices in Los Angeles and Orange counties. “Fifteen, 16 and 17 is a little young. You can call them mature, but 18 is more realistic.”
Some critics question the wisdom of a teenager having this surgery because it tampers with a developing part of her body.
“Give a youngster time to mature and wrestle with these decisions,” said Alan Solomon, a psychologist who practices in Torrance. “In the meantime, why not wear a push-up bra or falsies?”
Many teens with implants, however, voice no qualms about their decision.
“This is not social pressure,” explained the Huntington Beach senior, who has worn padding and push-up bras. “It is honestly just me and how I feel about my body.
Adolescence has always been about learning to live with changing bodies, but today’s media-driven images of beauty and women are unrelenting in their narrow portrayals of body types.
“I think society is driving this,” said Dr. Paul Schnur, president of the surgeons society who teaches at the Mayo Clinic in Scottsdale, Ariz. “If you look at ads . . . you see the gorgeous, thin, big-breasted figure is the idol.”
The media also are part of the drumbeat. Pop star Britney Spears, 17, received waves of recent publicity after reportedly getting implants. Affluence, too, plays a role in the growing trend, with some parents seeing implants as just another advantage for their daughters.
“Parents have extra capital to spend, so it is not unheard of for a 17- or 18-year-old to ask for and get breast augmentation for a graduation present,” said Dr. Robert Joas, a San Diego anesthesiologist who works only with plastic surgeons. “There is enough affluence in Southern California that they can say you can have both the BMW and the breast implants.”
Increasingly, daughters are being encouraged by mothers who are themselves veterans of the surgeon’s knife.
“It is a natural progression,” said Dr. Amy T. Bandy, a plastic surgeon who practices in the South Bay and Newport Beach. “Among the younger women I see, the ones who are the most comfortable have mothers who have had it done.”
“Teens see it [surgery] is available and say, ‘Why should I wait?’ ” said Dr. Robert Singer, a La Jolla plastic surgeon who is board chairman of the plastic surgeons organization.
Not every teen gets parental support. One 19-year-old Redondo Beach bank clerk fulfilled a yearning when she went from a B-cup to Ds--and alienated her family.
The clerk’s mother is upset, her father has stopped talking to her and her sisters can’t stop talking about it, she said.
“I didn’t do this because I wanted attention,” she said. And she laughed at her boyfriend when he suggested she shouldn’t have surgery to please him.
“I told him, ‘It is not for you,’ ” she said. “He told me to think about it and gave me the same speech my father did.”
In a society that magnifies every perceived flaw, it is not surprising that teenagers are subject to pressures pertaining to body image, according to several psychologists. But there are less intrusive ways to deal with self-esteem and self-image problems, they said.
A particular difficulty for teenagers is “the audience effect,” in which even healthy adolescents are easily embarrassed by things ranging from acne to a bad haircut to being seen with their parents, said psychologist Solomon.
“Teens walk into a room and are certain that everybody notices them and everybody is evaluating and judging them,” he said.
Solomon said he thinks it’s healthier to create internal mechanisms--rather than seek external change--to cope with such stress. Teens should develop “a greater sense of confidence and comfort within themselves because that improves the quality of life for years and years.”
The trend horrifies Clarissa Pinkola Estes, a Colorado psychoanalyst and the author of the bestselling book “Women Who Run With the Wolves.”
“Lots of women don’t get their breasts until 17 or 18 years old,” she said. “Until they have children, their reproductive bodies should be preserved.”
Adolescents are ill-prepared for the sexuality they are unleashing, she said.
“They are aware of looks [from men], but . . . they are unaware that it is all made of longing and no love. For a young woman, there is no way to understand that unless they have had some experience.”
Many surgeons, however, point out that the pressures on small-breasted teens are real.
“People say vanity is a bad word,” said Dr. Gary Brody, a plastic surgery professor at USC School of Medicine. “But vanity is what makes us comb our hair, shine our shoes and wear nice clothes and try to look good. . . . This is a basic human need, and it is wrong for a society to say these are just rich little girls whose parents are indulging them or that it is a silly thing and the fad of the moment.”
And for those who might think the trend is fundamentally frivolous, surgeons disagree.
“The perception often is that teenagers having this done are going into topless dancing,” Singer said. “I have patients who have done it when they graduated high school and are going off to Stanford, Yale and Harvard. . . . The end result is to see that they feel better about themselves.”
Although a majority of the augmentations on teens are done for cosmetic purposes, some correct problems such as asymmetrical development, doctors said.
That was the case for an Irvine high school student.
“I just wanted to be normal,” said the 16-year-old swimmer and water-polo player who had both breasts enlarged to get a symmetrical result.
Her parents agreed that the surgery would have been unnecessary otherwise.
“There are a lot of girls who are A-cup,” her mother said. “I would have told her, ‘Just live with it.’ ”
Doctors frequently confront the issue of who needs implants. One problem in selecting patients is that there is no standard for determining maturity--either physical or mental. For plastic surgery on the nose, the standard is to wait until the bones have reached 95% to 99% of full growth, which can be judged by measuring bone tissue. But breast tissue is extremely variable, and changes with weight and pregnancy and hormones.
Many of the medical risks of having implants are well known. Though technically simple, the procedure can cause infection, bleeding, implant leakage and complications involving scar tissue. It also commonly involves two hours of anesthesia or heavy sedation. Unlike older women, surgeons say, teens and others who have not given birth must consider the small possibility of later problems with nursing and dramatic skin sagging after pregnancy.
Dr. Mark Gorney, past president of the plastic surgeons group and a professor emeritus at Stanford School of Medicine, said he has mixed feelings about teenage surgery because “teens’ view of themselves are manifestations of immaturity. They are extremely unstable, and their narcissism is legendary.”
Gorney and others agree, however, that when “you do augmentation on the right candidate, they just blossom.”
