By Lori A. Bribitzer

What is the ultimate high school graduation present? Baby-boomers and Gen-Xers might have dreamed of receiving a new car or going on an exotic vacation. Today’s female graduates are asking their parents for larger breasts.

The number of breast augmentation surgeries that are performed on girls ages 18 and younger has increased nearly 293 percent since 1992, according to statistics compiled by the American Society of Plastic Surgeons.

"I think everyone always wants to be beautiful … and I just think bigger breasts are prettier," said Julie Nolan, an 18-year-old girl from Norfolk, Mass.

Nolan, a freshman at Sacred Heart University in Fairfield, Conn., doesn’t have breast implants, but would like to.

"If I had the money, I would get them," Nolan said, adding that she is considering having implants inserted later on in her life.

This attitude reflects a trend in society that is increasingly turning towards cosmetic surgery, particularly breast augmentation. According to the American Society of Plastic Surgeons, more than 250,000 breast augmentation surgeries were performed last year, a 657 percent increase from 1992.

With each year, the number of teens undergoing breast augmentation is increasing. These young girls are receiving breast implants as presents, often from their parents, for high school graduations and Sweet 16 birthdays. This has become particularly trendy with teens from affluent areas where cosmetic surgery is a popular and affordable option, as the cost of implants usually runs between $5,000 and $7,000. Except in rare cases of breast reconstruction, none of these expenses are covered by insurance companies.

Each expert has their own interpretation of this rise in the number of girls receiving implants, but most admit that society’s recent obsession with plastic surgery, especially on the part of young people, is due to a variety of issues.

"The blame lies in a combination of the plastic surgery industry, the media, and parents who do not adequately counsel young women," said Pam Dowd of Boise, Idaho, a survivor of breast cancer and three ruptured breast implants.

After surviving breast cancer at age 27, Dowd decided to undergo breast reconstruction and had a set of silicone breast implants inserted in 1981. Her first implant ruptured 90 days later.

For Dowd, this was only the beginning of a decades-long struggle for good health. Since then, she has been diagnosed with countless neurological diseases, which she believes are due to her faulty implants.

As the popularity of breast implants has increased, so has insistence from advocates and survivors like Dowd that the US Food and Drug Administration (FDA) ban all breast implants. As more teens receive implants, a battle that has been waging between the FDA and the silicone manufacturing industry for the past decade continues.

The FDA removed silicone implants from the market in 1992 at the recommendation of its advisory panel due to questions about the safety of the devices. According their decision, the implants could still be obtained under special circumstances, for women who have had mastectomies, but could no longer be used solely for cosmetic purposes.

But in October 2003, this argument was reopened when Inamed Corp., a silicone manufacturer, requested the FDA re-examine their 1992 decision. The FDA’s advisory panel held a two-day conference in Washington D.C. where dozens of medical professionals and implant survivors, including Dowd, testified regarding their experiences with silicone implants. In January 2004, the FDA ruled against Inamed, and the ban on silicone remained.

Inamed and other silicone manufacturers still claim that research has shown silicone implants to be comparable to saline-filled implants. Saline implants remain FDA approved for cosmetic surgery.

Inamed argues that silicone implants are approved in Europe and are often preferred by women over their saline-filled counterparts. According to silicone supporters, silicone implants look and feel more like natural breast tissue. Since the FDA’s ruling, other silicone manufacturers have followed Inamed’s lead and have begun to petition the FDA to allow silicone implants back on the market.

Ilena Rosenthal has spent much of the last nine years of her life fighting against Inamed and the rest of the silicone manufacturing industry. She began researching breast implants on behalf of a friend in 1995 and, after hearing tale after tale from women whose lives have been destroyed due to their implants, became an advocate for women who have been harmed by the industry.

Rosenthal, author of "Breast Implants: The Myths, the Facts, the Women" formed and directs the San Diego-based Humantics Foundation for Women, a national organization that serves as the world’s largest support group for women harmed by breast implants.

"People make choices all the time that may well harm them in the future," Rosenthal said. "They typically think the negative won’t happen to them. I’ve heard hundreds of times, ‘If I’d known then what I know now, I never would have made the choice of breast implants.’"

According to Rosenthal, the personal battle she decided to wage against the silicone manufacturing industry soon turned into a series of legal conflicts when members of that industry became irritated with her advocacy.

In 1999, she filed a defamation suit against Patrick O’Leary, then Vice President of McGhan Medical Corp, a subsidiary of Inamed. According to Rosenthal, O’Leary had been posting libelous statements against her on the implant support internet newsgroup she created. On the support group, he allegedly harassed and defamed those who spoke out against implants, never admitting his affiliation with the silicone manufacturing industry until Rosenthal realized the truth and called him on it.

O’Leary and several others posted discrediting statements about Rosenthal that ranged from "silly stuff … to horrid libelous accusations that I was a cocaine addict, a diagnosed psychotic and much worse," Rosenthal said. Rosenthal initially won her suit against O’Leary, but then lost in June 2001 when he forced an appeal.

More recently, Rosenthal is defending herself in what has become a significant and high-profile internet libel suit. This case, currently under the review of the California State Supreme Court, was filed in March by physicians Stephen J. Barrett, MD and Terry Polevoy, MD. They claim Rosenthal committed libel through posting, on an internet newsgroup, a copy of an email that refers to the doctors as being "quacks" and accuses Dr. Polevoy of stalking several women.

Despite the legal problems she has faced, Rosenthal has no plans to back down.

"I challenge the enormous amount of propaganda disguised as ‘news’ … and refuse to be silenced," she said.

Rosenthal argues that many young women remain uniformed about the risks of breast implants. According to her foundation’s website, ruptured implants can go undetected for years and the silicone in them is known to migrate throughout the body’s lymph system.

Additionally, links have been found between silicone breast implants and serious auto-immune diseases like Multiple Sclerosis and rheumatoid arthritis. And, even if a patient experiences none of these adverse effects, many women remain unaware that implants are not a permanent solution. Implants have a fairly short lifespan and will often need to be replaced within a decade.

No one ever told this to Sandra LaLiberte.

"I was told it would be beautiful," said LaLiberte, a middle-aged woman from Canada who underwent breast reconstruction after a double mastectomy in 1989. "Even the nurses said I would look great. Being 28 at the time I never thought much about it. What a mistake!"

When the bandages on LaLiberte’s breasts were removed, she was shocked by what she saw. Her implants were extremely high on her chest, near her neck.

"My plastic surgeon ordered an intern to come in and force the implant down," LaLiberte said. "It was excruciating."

Two months later, the implant "was so infected and hard it almost burst through the chest wall" and LaLiberte had the implant removed. Since then, she has been diagnosed with Multiple Sclerosis and is scheduled for her 18th operation to repair her abdomen area.

"Being 40 and disabled is not a nice thing," she said. "It affects all aspects of our lives … I am so ugly and mutilated I can’t even imagine who would want me for the rest of their life. I don’t even want me."

Despite the devastation some women experience from breast implants, still others argue that their implants have been a positive experience.

Nearly 5,000 women with implants responded to a survey conducted as a response to some of the questions that were raised during the FDA’s October 2003 investigation. Of those surveyed, 94 percent responded that they would recommend breast augmentation to friends and family members.

Additionally, the survey reports that 92 percent are happy regarding their decision to get implants, and 89 percent said that their augmentation either "completely" or "mostly" met their expectations.

Anna*, a 24-year-old mother of two falls within these categories.

"I am 100 percent satisfied with my results," she said.

Anna chose to have her breasts enlarged to a small C-cup after the births of her children left her breasts looking smaller and saggy.

Anna said that the decision to have a breast augmentation was hers alone, but admits that "society puts pressure on young women, which makes them feel less confident in they way they look, which drives them to a plastic surgeon."

Though thrilled with her results, she warns that "surgery should be made for women 21 and older" because younger girls "need to learn a lot more before having plastic surgery."

This warning is often lost on the young girls who are frequently relatively uniformed about the surgeries and cosmetic procedures they desire.

Doctors are ethically required to inform their patients of the risks they face in undergoing breast augmentation, and 93 percent of women surveyed confirm that they were indeed informed of those risks. However, the same survey cites that ten percent of these women were never told that their implants would not last forever. This mistake has advocates concerned that some surgeons gloss over risks and potential side-effects in their efforts to woo young women eager for larger breasts.

Adding to that, media critics claim that the nation’s recent reality TV craze has helped to create a society where girls view cosmetic surgery as a quick fix. Make-over shows like "The Swan" and "Extreme Makeover" are most popular within the 18-34 demographic and help to promote a desire for physical perfection amongst young girls.

"Everywhere we turn, we are bombarded by the media in all forms telling us we are not good enough as we are," said Dowd. "Our young women have become their new prey … What is wrong with telling a young woman she is wonderfully and beautifully made?"

*Name has been withheld at person’s request