For More Teenage Girls, Adult Plastic Surgery

Kacey Long, 22, of Ennis, Tex., holds one of the implants she had removed after they caused severe complications, including intense pain and fatigue. (Joseph Victor Stefanchik For The Washington Post)

Her D-cup implants were so big, she recalled, that she "looked like a porn star."

A few weeks after her surgery, Long said, she began experiencing shooting pain in her arms, followed by intense joint pain and crushing fatigue. She had trouble getting out of bed and spent months consulting doctors who told her they did not know what was wrong.

Last year a specialist in Dallas told her she had rheumatoid arthritis, suggested her implants might be responsible and recommended their removal. Her parents took out a $6,400 loan to pay for removal surgery. Since then, Long said, her health has improved.

Although many women continue to believe their implants made them sick, no scientific link has been conclusively established with autoimmune diseases such as rheumatoid arthritis, according to the FDA.

But the agency warns in a 2004 handbook for patients that "most women with breast implants will experience local complications" including pain, hardening and rupture. Recipients "should be prepared for long-term follow up, reoperations to treat complications and personal financial costs." Less common complications include numbness, infection and blood clots.

A 1999 report by the Institute of Medicine found that implants can interfere with breast-feeding, as well as mammography, by obscuring part of the breast, potentially resulting in delayed cancer diagnoses. Mammograms also can rupture implants, requiring their removal.

The FDA Web site features graphic photos of complications and notes that 45,000 augmentation patients had their implants removed last year. Removal, the FDA warns, could result in "undesirable cosmetic changes" such as permanently wrinkled, dimpled or puckered skin.

Magassy said that most teenagers who consult him are "so frightened" that they do not ask any questions. During the initial appointment, he said, he outlines the risks and assures patients that implants "are a very simple procedure and if you don't like it, you can take it out."

Psychologist Ann Kearney-Cooke, a visiting scholar at Columbia University who studies girls and body image, said the increase in cosmetic surgery among adolescents reflects a pernicious trend that pervades popular culture: the glorification of rail-thin, large-breasted women. It is, she notes, an unnatural body type rarely achievable without surgery.

"Kids spend a lot of time in chat rooms and they're bombarded by the media with these unrealistic images," Kearney-Cooke said. "When you're a teenage girl, there's this whole myth of transformation that's very powerful: namely that cosmetic surgery can transform your looks and your life.

"It's as though the question 'Who am I?' has been replaced with 'What image do I want to project?' "