Doc Urges Caution On Teen Breast Implants

Today, Jamie is a happy mother and wife. Ten years ago, she was a young girl dragged down by a low self-esteem.

"I had always had self-esteem issues throughout most of my childhood and teenage years, and most of it was because I was flat-chested," said Jamie, who asked that we not use her full name. "I never felt comfortable in anything that I was wearing."After seeing a plastic surgeon who specialized in younger patients on the news when she was 16, Jaime approached her mother about having her breasts enlarged.They went to see Dr. Frederick Lukash, who told them he didn't think high school was the right time to perform the surgery."He said it probably wasn't the best time because it wouldn't help my self-esteem to be the target of, 'Wow, did you just have your boobs done?'" said Jamie.After consulting with Lukash for over a year, Jaime had her breasts enlarged in the summer between high school and college, when she was 17."I was barely an A (cup) before my surgery, and now I am at a B, so my surgery wasn't to give me a DD exotic-dancer body or visions that I had seen on TV. It was just to feel comfortable in my skin," said Jaime."It just completely changed my life. I went to college just feeling good about myself, and I didn't have all the self-esteem issues. I made friends more easily. I met my husband. I was just happy with myself."

National Debate Over Breasts

The issue of young girls having breast augmentation became a national debate recently when Stephanie Kuleba, an 18-year-old high school cheerleader in Florida, went in for breast augmentation surgery on March 22 and died.According to her family, Kuleba was getting the surgery to fix asymmetrical breasts and inverted nipples.The story made headlines across the country. For example, on its Web site, Fox News reported, "But now, 18-year-old Stephanie Kuleba is dead, and her friends, relatives and family attorney are pointing to breast surgery as the reason."But it is believed that Kuleba did not die because of the type of surgery. Instead, she apparently died from malignant hyperthermia, a rare genetic disorder brought on by anesthesia.Lukash, who said he has performed many breast augmentations on girls under the age of 18 for a number of reasons, questioned why so much attention has been focused on the fact that Kuleba was having breast surgery and very little on malignant hyperthermia, a disorder that occurs in every 5,000 to 50,000 patients who are given anesthesia, according to the Genetics Home Reference."Because we hear the word 'teenager' and 'implant,' now the story has gone from teenagers and implants to, 'Is cosmetic surgery unnecessary in kids?'" said Lukash. "The whole story starts to snowball beyond what the original story was. That happens all the time."

Augmentation Of Minors Rare

The American Society of Plastic Surgeons reported that 47.4 percent of breast augmentation procedures on women under 18 in 2007 were cosmetic, but that only 2 percent of the nearly 400,000 breast augmentations performed were on patients under 18. (Note: An earlier version of this story mistakenly said 20 percent were on minors.)In its position paper about teenage breast augmentation, the ASPS pointed out a number of possible health risks that are involved with breast implants, including bleeding, infection, changes in nipple or breast sensation, capsular contracture, implant leakage and wrinkling of the skin over the implant that may require secondary procedures.The paper also pointed out that all surgery carries risks associated with anesthesia.The FDA and the ASPS are against the practice of patients under the age of 18 receiving breast implants for purely cosmetic reasons."(Breast augmentation) is not performed (on underage girls) unless there is an overriding situation, if it has been deemed a reconstructive case," said Lukash, a member of the ASPS group that wrote its position paper on the subject. "Asymmetrical breasts, sagging breasts getting uplifted plus augmented. There are certain protocols that allow you to do it at an earlier time."

Deeper Emotional Issues

Lukash said he will also perform breast augmentation on an under-18 girl if there are some extenuating psychological issues, which he said he only encounters every few years. That was the case with Jaime."I had been working with counselors. I definitely had deep issues," said Jaime. "(Lukash) definitely knew that I was having emotional and esteem issues. It was more than just wanting to enhance my body."Once the surgery was done, Jaime said it did more than just improve her body image."It was a ripple effect," said Jamie. "Once I felt better about my body, I could kind of not focus on that and harp on it as much. It was now, 'OK, I can improve every other area of my life.'"But even with Jaime's psychological issues, Lukash still took a cautious, slow approach with her, which he said he does with all his patients who are under 18."I say to them, 'I agree with you, but I don't think that the middle of high school is the time to do it where all your friends are going to notice a change. Why don't we do it during that transitional period?' And nine times out of 10 that satisfies them," said Lukash.Lukash said he thinks bad plastic surgeons who don't know how to say "no" to patients contribute to the negative reputation plastic surgery sometimes gets in the media."The media is only interested in two things: miracles and disasters," said Lukash. "They're not interested in covering mainstream, under-the-bell-curve plastic surgery. Someone's got an altered body image, they come in, they get it done, they're happy, they go on with their life. What kind of a story is that?"Jaime said Lukash's cautious approach was frustrating when she was 16, but she now thinks it was the right decision."Make sure it is something that you really want," said Jaime when asked what advice she would have for young girls seeking breast augmentation. "Make sure that you do your research and that you go to the best doctor possible, somebody like Dr. Lukash who is going to care about you and not just want to do the surgery to do the surgery."

Teen breast enlargement surgeries on the rise

By Melanie Lefkowitz and Beth Whitehouse
Newsday

MELVILLE, N.Y. — Before she underwent breast augmentation surgery last summer, Melissa Wohl said she felt self-conscious about her body — especially at the beach.

"I wasn't as developed as some of my friends, who were filling out their bathing suits," said Wohl, 19, of Wantagh, N.Y., who attends Binghamton University. "I guess I felt like I didn't fit in."

Wohl is among an increasing number of young women looking to plastic surgery for a boost in confidence as well as cup size.

Last week's death of Stephanie Kuleba, 18, of South Florida, during breast augmentation surgery has drawn attention to what some describe as a growing trend. Kuleba, whose parents say she sought the surgery to correct an inverted nipple and asymmetrical breasts, died Saturday of what may have been a rare genetic reaction to general anesthesia.

According to the American Society for Aesthetic Plastic Surgery, the number of women 18 and younger who have had breast enlargements has risen nearly 500 percent over the past decade — a sharper climb than the 300 percent increase in breast augmentations among all age groups.

Dr. Stephen Greenberg, a plastic surgeon in Woodbury, N.Y., estimated he has seen a 20 percent to 30 percent rise in cosmetic procedures among young people. Often, he said, a girl will come in with her parents, who are buying her a breast augmentation as a birthday or high school graduation gift.

"There are girls and women who are devastated by the fact that they don't have breasts and their friends do," Greenberg said. "They don't play gymnastics and they don't go on dates or they can't wear certain clothing, and I hear these things every day."

Greenberg attributed the trend in part to young women who see their parents undergoing cosmetic procedures, or relate closely to the celebrities who have them.

Not everyone agrees.

Dr. Alan Gold, a Great Neck, N.Y., plastic surgeon, noted that those 18 and younger accounted for only 2 percent of the nearly 400,000 breast augmentation surgeries performed nationwide in 2007. He said that while many might choose to have such a surgery in a "transitional period" like summer vacation when they won't see their friends every day, he has not seen a trend in graduation and birthday gift breast jobs among his patients.

Breast augmentation is the most popular plastic surgery, accounting for about 20 percent of all surgical procedures. It costs on average about $4,000, according to the plastic surgeons' society.

Traci Levy, an assistant professor who teaches courses in feminism and gender studies at Adelphi University, said that the growing perception that it's a common procedure, along with the bombardment of women with advertisements for plastic surgery, may be contributing to its popularity.

"To say that you need to have a very expensive surgical procedure with real health risks in order to be considered beautiful, I think, is a problematic image," she said.

The Food and Drug Administration recommends against performing breast augmentations on girls younger than 18, and both Gold and Greenberg said that if younger teenagers request the surgery, they counsel them to wait. But Gold said he sees nothing necessarily wrong with performing the surgeries on women who are 18 or older.

"Eighteen is certainly an age where we're putting men and women in uniform on a battlefield," he said. "I think they can decide if they want larger breasts."

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Before one can fully understand how a breast enhancement or breast enlargement product works, one must have a limited amount of knowledge of what causes a female body to develop breasts in the first place.

Scientific research has concluded that breast tissue growth occurs as a result of the effects of estrogen, progesterone, prolacin, prostaglandins, and human growth hormone. It is important that all of these hormones be present in the body in the proper balance for normal breast tissue development.

During childhood, estrogens are secreted in small quantities. Following puberty however, the quantity of estrogens secreted under the influence of the pituitary hormones (FHS, LH) increases some 20 fold or more. At this time sexual organs change from those of a child to that of an adult. The external genitalia enlarge. Estrogens effect on the breast causes fat deposition, development of the stromal tissues of the breast and growth of an extensive ductile system. Along with estrogen, progesterone and prolactin are secreted in higher quantities from the ovaries after puberty. These two hormones are responsible for growth of the lobules and alveoli of the breast determining growth and function of these structures.

Progesterone promotes development of the lobules and alveoli of the breasts causing the alveolar cells to proliferate to enlarge and to become secretory in nature. However, progesterone does not cause the alveoli to secrete milk unless stimulated by prolactin from the pituitary. Progesterone cause the breasts to swell partially due to changes in the lobules and alveoli, but also partly from increased fluid retention in sub-cutaneous tissues.

Scientists have proven that stimulating the estrogen receptors in the breast with estrogen or estrogen like substance (phytoestrogens), like those found in Breast Gain  can actually increase the size of the female breast as much as 150%.

 Summery

The estrogen initiate growth of the breast and are responsible for the characteristic external appearance of the mature female breast

In females where the ovaries don't produce sufficient amounts of estrogen and progesterone under developed breasts may occur. As females age, the ovaries slowly begin to produce less hormones, resulting in sagging smaller breasts. Scientific evidence shows that additional estrogen and progesterone may enhance breast growth.

Hormone therapy ( use of ethinyl estradiol or conjugated estrogen ) is used for the transexuals (male to female conversion) but it is risky for women for it's role in the etiology of breast cancer.

Phytohormones are estrogen like compound.Phyto-oestrogens can share some of the same biological activities with oestrogens produced in the body. Although Phyto-oestrogens are much weaker than the body’s own naturally occurring (or endogenous) oestrogens, oestrogen-like effects are apparent after the consumption of Phyto-oestrogens in many, if not all, of the oestrogen-receptive tissues in the body.

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