In a Rich’s-Macy’s changing room, Amanda Ross smiles as she squeezes her sinewy body into an orange nylon tank top.
“I never could have worn this before,” she says, sashaying before a full-length mirror.
“You look great,” says Paige Bellamy, trying on a white body-hugging shirt.
Ross and Bellamy, friends ages 19 and 18, recently did something once unthinkable for women so young: They got breast implants. They joined a surge of American women, many of them teenagers, lining up for breast enlargement like never before.
It’s a trend fueled by media, money and fading memory.
TV shows such as “Extreme Makeover” and “The Swan” make acquiring the body styles of the rich and famous seem routine. More women seem perfectly willing to shell out $6,000 or so for a new chest, even if it means going on a payment plan.
And many people under age 30 seem unaware of the claims by tens of thousands of women in the 1980s linking silicone implants to lupus, fibromyalgia, rheumatoid arthritis and other diseases. The Food and Drug Administration banned silicone implants for cosmetic use in 1992, and most implants today are filled with saline. Saline implants are considered safer, but they have silicone shells, and long-term health data remain sketchy.
“It’s extremely acceptable today,” said Dr. Frank Elliott of Atlanta Plastic Surgery, who has operated on nine women under age 20 this summer, more than double the number in all of last year. “It doesn’t have the implications of a shallow society anymore.”
Dr. Win Pound, also a plastic surgeon in Atlanta, has noticed breast enhancements replacing cars as high school graduation gifts. “I’ve seen a run of girls right out of high school this summer,” he said.
Some see the renewed demand for bigger bosoms as a positive way for less endowed women to boost their self-esteem. Others wonder whether patients, especially teenagers, carefully consider the potential complications cited by the FDA: pain, wrinkling or hardening of the breast, interference with mammography and future breast-feeding, the eventual need to replace implants, and health insurance denials or increased premiums.
“When you’re talking about teenage girls who obsess about how they look, you’re dealing with a very vulnerable population,” said Diane Zuckerman, president of the National Center for Policy Research for Women & Families. “You don’t want them to be making decisions about plastic surgery.”
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`I really love them’
Ross, a veterinary assistant and aspiring model from Cumming, Ga., who is paying $160 a month (for four years) for the treasured 34C chest she acquired recently, said her motive wasn’t complicated.
“People always say, `Oh, you must have low self-esteem,’ but that was not it at all,” she said. “All my friends have big [breasts]. And I wanted them too. . . . It’s not like I think I can get a boyfriend with these.”
As she stood before the mirror on a recent shopping spree, Ross–who looked as if she was plucked from a modeling runway even before the implants–reveled in her new desire to wear low-cut dresses and backless tops. She cupped her enlarged breasts and leaned her head toward her shoulder with a dreamy gaze.
“Sometimes I just like to hold them, and I think to myself, `I really love them,”‘ she said.
Ross and Bellamy said they see implants not as a life-altering experience but as a cosmetic improvement, like teeth whitening or blond highlights. And they haven’t worried much about side effects.
Ross said she hasn’t thought a lot about the need to replace the implants, which health officials say is required every 10 years or so. “I’ll be an older woman then,” she said.
Bellamy, who said her implants make her feel “sexy, more like a woman,” admits that she only pretended to read the waiver forms about possible complications from the surgery. “I didn’t want to freak myself out, so I wouldn’t read it,” she said.
Of the 280,401 women who received cosmetic breast implants last year, 11,326–or 4 percent–were under 19, according to the American Society for Aesthetic Plastic Surgery. In previous years, that age group accounted for 1 to 2 percent of the total. Statistics from the American Society of Plastic Surgeons are more conservative, saying 3,841 women under 19 got breast implants last year. That’s a higher percentage of its total than in the last two years. Both groups report a doubling of all breast enlargement surgeries during the last five years.
The FDA has approved breast implants for women 18 and older. But doctors can put implants into younger ones at their discretion, said FDA spokeswoman Sharon Snider. Doctors require adult consent for those under 18.
Many plastic surgeons say they won’t operate on women under 18 unless there is a “compelling” reason, such as uneven development of the breasts, a completely flat chest or extreme psychological distress.
“I’m not sure [teens] realize what is involved,” said Dr. Foad Nahai of Paces Plastic Surgery in Atlanta, who is secretary of the American Society for Aesthetic Plastic Surgery. “It’s best for someone who has had her family.”
Regulators and manufacturers say implants are safer today, but health officials say research on long-term effects is insufficient.
“Many of the changes to your breast following implantation are irreversible,” warns a brochure from Mentor Corp., a leading manufacturer of saline implants, which says the devices carry a low overall risk.
This summer, silicone implant maker Dow Corning started issuing payments from a $2.35 billion lawsuit settlement in 1999 to about 170,000 women who claimed their implants had caused immune system illnesses. A 1999 government report found no conclusive link between the implants and disease but called for more research.
The FDA says one-fourth of women with implants require surgery to repair or replace the devices within five years, with about half of those with silicone implants needing additional surgery within 10 years. Some experts say the newer saline implants last longer.
One-third to two-thirds of women with implants have insufficient milk for breast-feeding, the agency says. And small amounts of silicone may pass from implant shells into breast milk, possibly affecting a nursing infant.
Unnatural standards?
For many women, the desire for breast implants, along with general feelings about their bodies, can be traced to their mothers, said Sachs, the Minneapolis psychotherapist. Young girls internalize their mothers’ bodily insecurities, she said. “It starts when the girl is 3 years old, and the mother says, `I am not going to put a bathing suit on because I am so fat.”‘
Ross’ mother, Teresa Ross, has had breast implants and a breast lift. The mother, 50, said she was initially hesitant about her daughter’s following suit.
But “I knew I couldn’t stop her,” Ross said. “While I don’t think she needed it, I think it turned out beautiful.”
Some say the rise in breast augmentation reflects women’s increased control over their lives.
“If we’re making changes in our body that make us feel better, it’s empowering,” said Dr. Michelle Copeland, a New York plastic surgeon and the author of “Change Your Looks, Change Your Life.”
“With breasts, all the diet and exercise in the world is not going to give the improvement we want. It can be very frustrating for women who care about their body.”
But Zuckerman, of the National Center for Policy Research for Women & Families, said the supersizing of breasts suggests that society’s standards of beauty are becoming unattainable naturally.
“We have 95-pound women with 36C chests,” Zuckerman said. “Girls are comparing themselves to women who have undergone considerable plastic surgery, airbrushing on magazine covers and probably computer enhancement as well.”
Mental health experts worry that women, especially younger ones, may think that breast implants will benefit every aspect of their lives, which can trigger depression if improvement doesn’t occur.
“It doesn’t mean they’re suddenly going to enter into a great romantic relationship,” said Dr. Diane Thompson, an associate professor of psychiatry at Emory University. “This is not going to take away the embarrassment they felt as a child when they got teased.”
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In the changing room at Rich’s-Macy’s, Ross and Bellamy laughed off suggestions that their body modification stems from psychological woe. They see it more as a rite of passage.
As the two piled up cheerleader-style skirts, they boasted about all the clothes they can now wear.
And Bellamy readied her defense against those who would say that what they’ve done is frivolous.
“OK, then, why wear makeup?” she asked.