Florida teen's death after breast surgery draws questions
By Elizabeth Cooney, Globe Correspondent
The death of a Florida teenager after breast surgery, even though it was triggered by a rare reaction to anesthesia, is raising questions about operations to improve young patients' appearance.
Stephanie Kuleba, 18, died Saturday in an outpatient surgery center in Boca Raton after she suffered a reaction to general anesthesia. She was having surgery to correct inverted nipples and breast asymmetry, which would typically involve placing an implant in the smaller breast to match the bigger one.
While he is not familiar with the case, a spokesman for the American Society of Plastic Surgeons said under the group’s guidelines, almost no one under 18 would get breast augmentation surgery because of the difficulty obtaining truly informed consent. He does few rhinoplasties, or “nose jobs,” in patients under 17 for the same reason, although parents are responsible for medical decisions involving their minor children.
“Young people see only the end results: bigger breasts,” Dr. Richard Ehrlichman, a Wellesley plastic surgeon, said in an interview. “They don’t see the risks, they don’t see what recovery means.”
Dr. Brian Labow, director of the Adolescent Breast Clinic at Children's Hospital Boston, bristled at using the word "cosmetic" to describe the surgery the girl was having, or when asking, in retrospect, whether she really "needed" it. He was not involved in the case.
"When we're talking about breast deficiency after mastectomies, no one talks about that as 'cosmetic,' " he said in an interview. "It's a bit of a double standard when you have an underdeveloped breast. I don't understand the difference."
Patients tell him how miserable they are with breasts of markedly different size, beyond the small degree of asymmetry that 80 to 90 percent of women have. Even so, surgery is not the first option. A 14-year-old girl, for instance, will be offered other solutions -- inserts for their clothes -- until their bodies mature.
Breast reductions are more commonly performed on adolescent girls if they are suffering from back pain or rashes and can’t comfortably carry out daily activities because of the weight of their breasts, Ehrlichman and Labow said. Insurance companies are more likely to pay for those procedures, too.
Deciding where medical necessity ends and quality of life begins can be difficult to determine. But the risks of every surgery, elective or not, are certain, Ehrlichman said.
“It should never be taken lightly,” he said.
Another issue in this sad case is the envirponment in which the surgery took place: an outpatient facility as opposed to a traditional hospital operating room. Did this facility, favored by surgeons because of lower costs, have the resources and expertise to resuscitate (if possible) this young patient?
she died of a complication of anesthesia...not plastic surgery.
most patients don't have Malignant Hyperthermia...thats what she died from...a very rare reaction to general anesthetics.
Why can't 18 years olds sign up for this surgery? They can sign up for the military! Are we going to start really questioning the 18 year olds signing up to go to war? If they can't give truly informed consent for a surgery, how can the government say they're getting informed consent?
what is Malignant Hyperthermia and how do u die from that and anesthetics?
I believe the article stated that one needed parental notification if they were under 18. At 18 one can make the decision on their own, just like joining the military and voting.
From the article: "almost no one under 18 would get breast augmentation surgery because of the difficulty obtaining truly informed consent."
This is just more media nonsense.... Her death was caused by something not even remotely connected to the risks of the actual surgery. She could have gotten dental work and had the same fate.
Seems that it is fairly pathetic that people feel the need to make carte blanche declarations as to what is an isn't acceptible. Don't lie and say people don't understand the risks... Because they are certainly informed of them.
Ask yourself this question: Do beautiful people have an edge in life over non beautiful people?
Is self esteem tied to feelings of general wellness in life?
Should people have free will?
In conclusion: Worry about yourself first.
In regards to the comment above they are not saying that 18 year olds can not consent for surgery. They are saying that those UNDER 18 can not consent to having surgery.
My last comment is this:
The article insinuates that 18 years old is too young to allow people to act as adults and choose freely for themselves.
Why have any age as 'adulthood', if the purpose is simply to make predetermined 'acceptible' decisions.
First Amendment only exists when the government isn't imposing their will on you.
Would everyone stop this you can join the military crap at 18. I am in the Army and I can't stand this. When you enlist in any branch of the service you give up your rights and personal identity to an extent and breast augmentation is for enhancement. People join the military for a chance to serve their country, better themselves not only PHYSICALLY but MENTALLY AS WELL. PEOPLE USE IT AS AN OUTLET TO GET AWAY FROM BAD SITUATIONS OR TO MAKE NECESSARY CHANGES NOT TO GET BIGGER BOOBS. So please think before you type.
It was so sad to read about the 18 year old Florida cheerleader who died from complications of a breast augmentation, and my heart goes out to her family and friends.
For me as a cosmetic surgery consultant, when I hear of a cosmetic surgery ending in tragedy, it’s also a wake up call for patients, and I remind all my clients who are considering surgery, you’ve got to prepare for it…Any surgery is risky, but those risks can be minimized by taking certain crucial steps to safety-proof your surgery. In the case of the West Boca High School cheerleader, they suspect a rare condition triggered by anesthesia.
That’s why I warn people, you’ve got to fully disclosing all medications you are taking, including over the counter drugs, herbs, vitamins or any drugs, legal or illegal—that could dangerously interact with anesthesia. We won’t know what happened until the autopsy, but if even if you are taking over the counter cold medicines, tell your surgeon—and the anesthesiologist.
People don’t die from actual surgery, but from complications, and it’s as important to choose a top anesthesiologist as it is to choose your plastic surgeon.
I’m not blaming, it could happen to any surgeon. It’s a tragedy for everyone, including the board-certified cosmetic surgeon who performed the operation in a private surgery facility.
As a physician, I find it very disturbing that the people caring for this child were so unprepared to deal with her situation that they had to call '911' for assistance. Such a lack of processes to provide standard of care for a rare, but foreseeable, emergency is negligent .
To my knowledge, malignant hyperthermia when recognized and treated properly is not universally fatal and, in fact, the vast majority of patients can be successfully treated. Perhaps even in the best case scenario this patient is one of the minority of patients who cannot be resuscitated, but having doctors who have to make a phone call for assistance is far from the best case scenario. It's the the worst case scenario.
I have given anesthesia for 23 years. The cause of her death was related to the MD anesthesiologist not providing the proper medication in a timely manner after the Malignant Hyperthermia "MH" appeared. Death from MH should not occur in this day and age. I had a patient with MH about two years ago who did just fine. I am not even a physican, I am a "CRNA" nurse anesthetist. To achieve a successful outcome, you must identify the problem promptly, then treat MH immediatly with a drug called Dantrolene. Time is critical in producing a successful outcome. If the drug needed for treatment (Dantrolene) was not immediatly available in the office, then a general anesthetic should not have been given. The Surgeon and the Anesthesiologist both will "go down" in court if they didn't have Dantrolene at the facility where the surgery was performed.
There's a very good summary of what malignant hyperthermia is at: .
sad..
sad that people can't accept themselves for who they are
this is so very sad , a very sad loss this girl had her whole life ahead of her , but i think in this case she might of had the same reaction if she had any kind of surgery , doesn't the PRE OP , they have before you under go surgery spot things that might lead to complications , did this girl have a PRE OP before undergoing this surgery , as for her having breast surgery , she was 18 and could consent to it on her own , maybe it was something she needed to do for herself , i wonder if she had ever had surgery before , well anyways
may prayers be with her family during their sad sudden loss , this story really just breaks my heart i have a 18 year old daughter myself
As a perioperative nurse of 25 years, I have seen only one "possible" case of Malignant Hyperthermia. It is a life threatening anesthesia complication. It has a very specific, time intensive protocol and to the CRNA who "treated her patient timely" I can only say you have not been around long enough to make such a comment. If there is one thing I have learned in all my years in nursing, (I went into the OR from nursing school) is that hind sight is 20/20. Just when you think you know all the answers, guess what, you don't. As in any emergency, time is of the essence and by the grace of God, most patients will survive. I counsel our patients constantly to provide correct, timely and COMPLETE information to the staff and physicians. You would be surprised how many patients do not even know the names of their medications, as well as what they are used for! To the Physician who stated he was "disturbed"at the 911 call, he obviously does not work in an ambulatory surgery center that is freestanding. Part of our emergency protocol is for someone, usually ancillary, to call 911 if not for anything else but to transport the patient to the area hospital. I could write a book on misinformation and "expert" comments, however there is not enough space. To the family of this patient, my prayers are with you, and to all the healthcare personnel involved, my prayers are with you as well.
Jennifer -- Actually the CRNA (Nurse Anesthetist) with 23 years of experience is well qualified to have an opinion on this matter. Time is of the essence when it comes to an emerging case of Malignant Hyperthermia. An anesthesia provider, be it Anesthesiologist or CRNA, needs to be vigilant and react to changes in the patient condition rapidly. I question whether the site where the MH death took place even had Dantrolene on hand, as it is expensive and has a limited shelf-life. Since MH is rare, most OR staff have never seen a case, and would only know how to react throught training, or by the instruction of a qualified individual such as the anesthesia provider. I have practiced anesthesia in an area of the country that is a hot-spot for MH, and have successfully provided anesthesia for individuals known to have the MH trait. Out of all of this, the question should be -- Was the site that the surgery took place at adequately prepared to deal with this type of emergency? If they did not have the Dantrolene on hand, they should not have been administering an anesthetic using know MH triggering agents. Plain and simple.
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