Teen Girl Death after Breast Augmentation Surgery: Who's To Blame
Stephanie Kuleba was 18, a senior at West Boca High School in Boca Raton, FL, was already accepted to college, and was already thinking ahead to attending medical school and being a doctor. “Was” is a sad word here. Stephanie died after having breast augmentation surgery in the office of a Boca Raton plastic surgeon.
A lot is being made of the fact that Stephanie was having breast surgery. A lot is being made of the fact that she was a blonde young woman, in a well-to-do town, who was already beautiful, and was the head cheerleader at her high school.
Those facts are neither here nor there. Stephanie died because of an inherited condition called malignant hyperthermia (MH) that made using gas anesthesia very dangerous for her. She had never had any anesthesia in the past and there was absolutely no way for her, her parents, or her plastic surgeon to predict that having gas anesthesia was dangerous for her.
The vast majority of plastic and cosmetic surgeries take place with no problems. A spokesperson for the American Society of Plastic Surgeons has stated that out of 1.4 million plastic surgery procedures performed in outpatient settings, it has never been alerted to a case of MH. This is a very rare condition.
Malignant hyperthermia is very rare but very dangerous. It is a condition in which the body reacts badly to certain anesthetics called volatile gas anesthetics, including halothane. The muscles of the body react by rapidly increasing their metabolism and need for oxygen. Muscles become rigid and the body temperature can shoot up to 110 degrees. If the conditions is not treated and controlled, the patient goes into circulatory failure and dies. (MH is not related to hyperthermia or heat stroke, which can be caused by a combination of exercise and hot weather. Having had heat exhaustion or heat stroke does not put you at any risk of MH.)
Stephanie was having breast surgery to correct an asymmetry of her breasts through augmentation and to correct an inverted nipple. Her surgeon, Steven Schuster, MD, operated on her in his medical office, a common practice with breast surgery. News reports say that an anesthesiologist, a medical doctor trained in anesthesia, administered her anesthesia.
The Malignant Hyperthermia Association of the Unite States (MHAUS) calls the condition a silent one. You can live your whole life in perfect health and never have a problem, but if you have surgery and are treated with certain gas anesthetics, you can die. MH is inherited. If one of your parents is susceptible, you have a 50% chance of being susceptible, too. If your parents never had gas anesthesia, you might not know you are MH susceptible. It appears that Stephanie Kuleba didn’t know she was susceptible and there is no easy test to find out.
Until relatively recently, there was also no treatment for malignant hyperthermia and 80% of people who developed the condition during surgery died. Now, between 5% and 10% of patients who develop malignant hyperthermia die because of a drug called dantrolene. Dantrolene must be administered quickly and most hospitals keep it in stock. MHAUS also has a hotline for health care professionals to call and get immediate information on how to deal with MH.
Dr. Schuster called the MHAUS hotline for advice during the crisis with Stephanie, according to news reports. Paramedics were called and she was taken to a local hospital, where she was treated further. However, it is not known if Dr. Schuster had dantrolene on hand in his office and whether the drug was administered there. Dantrolene costs $2,200 for 36 units, enough to treat one large person, but the drug must be mixed with sterile water and be given intravenously. Treatment of MH also includes stopping the anesthetic and cooling the body.
The MHAUS recommends that all facilities that use volatile gas anesthetics have dantrolene on hand and know how to use it. They also strongly advise anyone who has a family history of MH to wear a special medical ID bracelet to make health care workers aware of that fact. If someone in a family has an incidence of MH during anesthesia, all family members including cousins should be alerted to the fact that they may be susceptible.
So what does this mean to anyone considering plastic surgery? It should drive home the fact that no surgery should be entered into lightly. All surgery carries risks. Anesthesia carries risks. Just because you go home the same day as your surgery does not mean that nothing bad will happen.
Even if you are worried about MH, you should know that most types of anesthesia are perfectly safe even if you are susceptible. The problem occurs specifically with certain types of volatile gas anesthesia. All local anesthesia is safe and there are many types of general anesthesia that can be used even on an MH-susceptible individual. MH-susceptible people can even have same-day surgery and go home after a few hours of being monitored.
As I said, much has been made about Stephanie being a blonde cheerleader. Not about the fact that she had fabulous grades or a winning personality, which she apparently had. The only small silver lining to this cloud is that we now know more about a rare but deadly complication of surgery. We should keep Stephanie and the Kuleba family in our thoughts.
* Image is courtesy of ABC News
Valerie
2 Comments
View Printer Friendly Version
Email Article to Friend
Reader Comments (2)
i find it really upseting that such a young girl with a bright future ahead of her could die such a terrible death
but needless to say, she was the one unaware of the risks and therefore the one at fault.
she obviosly ignored the warnings and was a superficial young girl who didnt think before she reacted.
her death is upesting, but a guide to any other stupid little girl who reckons who we are on the outside is more important than what we are blessed with on the inside.
I hardly feel that becuse she was unaware of the risks, she is at fault and deserves no sympathy. Claiming that she was superficial because she chose to have breast implants (implying we are all superficial to get breast implants) and should be used as an example to other "stupid little girls" (which in itself implies one is stupid to get breast implants) is pretty harsh INMO.
Death is usually tragic on any level regardless if they are young, old, or have breast implants. Having plastic surgery shouldn't exclude one from being sympathetic to a young one's death. mentioning the fact that it is upsetting, doesn't dull the fact that you say she is stupid and it is her own fault for dying. Although you are entitled to whatever opinion you wish, I feel it is a "no-fault" tragedy--period.