Embedded Files
Page 5
Children’s body image concerns may be further influenced by sociocultural influences such as dolls, television characters, and characters in children’s books and movies [18]. Researchers have shown that young women that watch more television programs featuring women with “curvaceously thin” ideal body images are significantly more likely to report that those types of bodies are their personal ideal and also express significantly more positive views of breast augmentation and liposuction [19]. The adolescent body image is continually developing in response to internal and external cues, and the physical changes of puberty occur at a time when teens are especially sensitive to how others look and what others think [10]. Self-esteem and self-worth also develop early, and can either be stable traits or states that are subject to change over time [20]. Research indicates that global self-worth tends to vary over time for students whose self-esteem is primarily dependent on the feedback of others, whereas those whose feelings are primarily dependent on self-approval have a more stable sense of self-esteem. This research has implications for why adolescents want plastic surgery, as well as the extent to which plastic surgery is likely to improve their self-esteem. A Dutch study examining the psychological benefit of cosmetic surgery among 12- to 22-year-olds, found that satisfaction with the body parts that the patients considered deformed improved 6 months after cosmetic surgery, especially for breast reduction and augmentation patients [21]. However, the no-treatment comparison group of Dutch adolescents with self-reported deformities also felt better about themselves 6 months later, especially among those 18 and older. These results suggest that body image improves among teenagers as they mature, whether or not they undergo cosmetic surgery. Similarly, a longitudinal study of adolescent males and females, ages 11 to 18, found body image satisfaction rates were highest at age 18 in both sexes, and that the satisfaction of individual participants varied as a function of their age and developmental stage [22]. Overall, these studies indicate that dissatisfaction with appearance decreases with age throughout adolescence, and also many adolescents who are very dissatisfied with their appearance will feel more satisfied as they mature, especially after the age of 18, even if they do not undergo cosmetic surgery. Mental Health and Cosmetic Surgery The ultimate role of plastic surgery has been described as “To alter the patient’s body image, and thus to improve the patient’s quality of life” [10]. However, research indicates a more complicated relationship between cosmetic surgery and mental health variables such as self-image and quality of life. In general, women report satisfaction with breast augmentation in the year following surgery [12,22]. However, six long-term retrospective studies indicate that breast augmentation patients are significantly more likely to commit suicide, compared to women of similar age who had other plastic surgery or represent the general population [23]. The six studies did not examine whether mental health problems developed before or after surgery, although several of the authors speculate the problems predated surgery. If mental health issues predate surgery, better screening and referrals are needed. On the other hand, if mental health problems develop or worsen after surgery, it is important to determine why this is occurring. The research literature on eating disorders provides useful clues about body image and its implications for adolescents’ motivation to undergo plastic surgery. Studies indicate that distorted body image and other mental health issues, rather than actual weight problems, are the main incentive for adolescents to go to extreme measures to lose weight [24]. It is logical to consider that similar problems may be influencing the desire for liposuction, and whether girls or women with eating disorders or distorted body image might be especially likely to seek liposuction. device, and increase over the lifetime of the product. The most common is capsular contracture, a tightening or hardening of the scar tissue surrounding the implant, which may cause the breast to feel hard and painful [10]. Other common complications include implant rupture, leaking, and the need for additional surgery. Postoperative bleeding and hematoma formation, reactions to anesthesia, loss of nipple sensation, and scarring are other complications of surgery. In about 1% of patients, infection develops around the implant. The medical risks of breast implants increase in the years following surgery. Although little research has been done, it is possible that problems associated with macromastia such as back pain may also occur among women with large breast implants [11]. Breast implants typically last approximately 10 years. The likelihood of capsular contracture and other complications requiring surgery also increase over time, so that an adolescent who undergoes breast augmentation may require repeated surgeries, with the associated risks, throughout her lifetime [12]. In several studies, breast augmentation surgery was found to increase the likelihood of insufficient lactation when a woman tried to breastfeed. Studies consistently indicate that breast implants interfere with mammography, causing a failure to detect approximately 55% of cancerous breast tumors. This is approximately twice the rate of women without implants [13]. Mammography procedures also increase the likelihood of implant rupture and leakage [14]. Liposuction The two medical societies differ somewhat in their estimates of liposuction procedures performed on adolescents, based on surveys of their members. ASPS and ASAPS estimates of liposuction performed from 2004 –2006 vary between 3000 and 6000 per year for adolescents under 18 –19 [1,9]. Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas. Through a tiny incision, a narrow tube or cannula is inserted and used to remove the fat layer that lies beneath the skin. After the incision is closed, the tunnels left by removal of the fat collapse and contract. The result is a reduction in the contour. When the procedure is small, it can be done under local anesthesia on an outpatient basis. When it is more extensive, general anesthesia and overnight stays are necessary. The acute adverse reactions following suctionassisted lipectomy consists of itching, bruising, and swelling. The patient must wear a compression garment for approximately 1 month to prevent hematoma formation, and bruising may last for 4 – 6 weeks. In addition to surgical risks, primary risks of liposuction include infection; damage to skin, nerves, or vital organs; fat or blood emboli; and excessive fluid loss [15]. The different techniques (tumescent, superwet, and ultrasound-assisted liposuction) are associated with additional complications such as skin or deep tissue damage. The American Society of Plastic Surgeons’ advisory states that the likelihood of serious medical complications, such as lidocaine toxicity and fluid accumulation in the lungs, increase with “the number of sites treated and the volume of fat aspirated” [16]. D. Zuckerman and A. Abraham / Journal of Adolescent Health 43 (2008) 318 –324 319 Pubertal Development and Body Image Physiological and psychological changes occur during puberty, which are important to consider when discussing cosmetic surgery in adolescents. Breast development can continue after age 18. In fact, when the FDA approved silicone gel breast implants only for women ages 22 and older, they pointed out that breast development can continue into the late teens and early 20s [17]. Breast size may also increase with weight gain, and growth charts indicate that the average female gains weight between the ages of 18 and 21. Normal weight gain may reduce dissatisfaction with breast size and the desire for breast augmentation. In addition, that same weight gain may also increase fat deposits in the areas most likely to be considered for liposuction. Therefore, the likelihood of weight gain in the late teens and early 20s raises important questions about whether decisions about either breast augmentation or liposuction for adolescents should be delayed. For augmentation, the desire for surgery could be reduced as a result of likely weight gain, whereas for liposuction, the benefits of surgery could be short-lived as a result of likely weight gain. The process of body image development begins at an early age. Parental approval and attention, or parental criticism and neglect, influence how children think about themselves. Children’s body image concerns may be further influenced by sociocultural influences such as dolls, television characters, and characters in children’s books and movies [18]. Researchers have shown that young women that watch more television programs featuring women with “curvaceously thin” ideal body images are significantly more likely to report that those types of bodies are their personal ideal and also express significantly more positive views of breast augmentation and liposuction [19]. The adolescent body image is continually developing in response to internal and external cues, and the physical changes of puberty occur at a time when teens are especially sensitive to how others
Google Sites
Report abuse