In the past decade, network television has been bombarded by a plethora of reality makeover shows. On shows such as "The Swan" and "Extreme Makeover," women are encouraged to change their inner persona by reconfiguring their physical appearances. These shows, in conjunction with other images and ideas in popular culture, cause many people to be unsurprised by increases in the number of females seeking cosmetic surgery as a viable option for increased self-esteem.
According to the American Society of Plastic Surgeons, rhinoplasty is still the most performed procedure among women, but now more women are making their way to the doctor's office to get breast implants. Breast augmentation procedures have grown 657 percent in the last decade, whereas nose reconstruction has grown only 3 percent.
Half of all cosmetic breast augmentations occur in the 19 to 34 age demographic, according to the ASPS. A growing trend is for college-age students to receive implants as graduation or birthday gifts.
"I believe very strongly that reality television shows of plastic surgery promote unrealistic expectations of plastic surgery," said Peter Fodor, American Society for Aesthetic Plastic Surgery president. "They make light of surgical procedures. These shows do have an affect on how patients perceive the seriousness of these surgeries."
Despite this growing trend, stigma toward breast augmentations still exists. Many college-age implant patients across the national media refuse comment or speak to reporters only on conditions of anonymity, according to the Washington Post.
Second-year College student Marian Callaham, said she wanted cosmetic surgery herself as a young girl, and felt the societal pressures for cosmetic surgery.
"You feel like you're not good enough, but what's telling you you're not good enough?" she said.
Callaham said she remembers wanting liposuction and a nose job as early as age 12, but said she would not get any cosmetic surgery done now.
"I felt I would be a lot more liked and I would probably like myself better but mostly that other people would like me more if I were prettier," Callaham said. "I wanted outside approval. I would say in general, that's why a lot of girls want it."
Not all breast surgeries, however, are done for purely cosmetic reasons. According to Fodor, a significant percentage of those who choose to get breast reconstruction do so to correct malformations -- in 2004, 60 percent of breast augmentation surgeries performed on girls 18 and under were procedures to correct uneven development or malformations.
Thomas Gampper, a plastic surgeon at the Aesthetic Center of the University Medical Center, agreed many women choose to get breast augmentation for reasons very different from those stereotyped in the media.
"Very few women have two breasts that are identical, but when it's significant and severe enough they'll want reconstruction," Gampper said. "Sometimes there's complete absence of a breast."
Instances in which one breast is completely absent in a patient usually occur as a result of cancer but can also be the result of underdevelopment. Some patients, especially cancer patients, choose to use their own muscle tissue to construct a breast mound, according to Gampper.
"We get a lot of patients with cancer. We use what is called a TRAM flap. You take muscle from the stomach wall and rebuild a breast mound. A lot of people want to use their own tissue and not a foreign body," he said.
For some women, bigger is not necessarily better. Third-year College student Ashley Lowe said she saw breast reduction as an option as early as her sophomore year in high school. Difficulty finding bras and the inability to wear popular shirts such as halter tops or anything strapless without appearing too revealing and being uncomfortable were among her reasons for wanting to get a breast reduction.
"Being a swimmer ... [and] being large chested was a great disadvantage," Lowe said. "They inhibit your range of motion."
Lowe added, however, that much of her desire to receive a reduction came from her perceived appearance to others.
"There are certain things you just can't wear without looking slutty," she said. "But I think mostly it was a self-conscious thing. I felt they were too big. I wanted people to see me as a whole instead of a girl with 'big jugs.' I feel some people have real trouble with that."
But not everyone is eligible for breast surgery. Many doctors have very specific guidelines for determining whether to perform breast augmentation on young female patients. One question doctors face is determining what age is appropriate for young women to receive cosmetic surgery.
Fodor has specific requirements for his patients, such as having had a menstruation cycle for at least a few years.
"When [girls] start menstruating the breasts usually do not grow that much more," Fodor said. He added that the patient's growth must have stabilized, the patient's parents must approve and the patient must be motivated to have the surgery rather than being pushed to do it from an outside source.
Lowe disagreed, saying that all females are susceptible to outside pressure to change themselves.
"In order for a woman to want plastic surgery for her own self she would have to have been isolated from the pressures of outside society, and that's not possible," she said.
Encouragement from mothers and peers enhance girls' self-esteem, thereby making it less likely that they will feel the need to physically alter themselves, according to a study published last fall by two University of Florida professors.
Callaham added that the practice of some parents allowing their young daughters to get implants for purely cosmetic reasons sends the wrong message.
"If parents let their daughters get that surgery it's like saying, 'Yes you need it -- how you look is what matters. I care more about that than your being a full person,'" she said.
Many young girls are still willing to face the risks associated with breast implants head-on. The ASPS also reports that over 4,000 young girls, as young as fourteen, choose to get breast implants each year.
Many others are opting to get other cosmetic surgeries such as rhinoplasty, liposuction or tummy tucks. According to ASPS statistics on the national population, more than 8.7 million cosmetic surgery procedures were performed in 2003 -- up 33 percent from 2002. A total of 11.9 million procedures were done in 2004, an increase of 44 percent.
Although the FDA recently has concluded that breast implants do not cause cancer, breast reconstruction may have serious consequences for women, especially young girls.
Such consequences may include loss of sensation in or hardening of the breasts, hematoma, infection, interference with mammograms, difficulty breastfeeding and the risk of a rupture that may cause illness. There is also the need to replace the implants every five to 10 years, according to the ASPS.
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