Stephanie Kuleba’s friends called her “Sunshine” because that was the perfect nickname for the outgoing and bubbly girl who was everybody’s friend, the cheerleader with the near-perfect grade-point average who was too nice and too perfect for anybody to resent.
“She was just the kind of girl that everyone loved,” a friend, Dayna Mercer, told NBC News. “There was nothing bad about her.”
But the 18-year-old high school senior, who was headed to college and then medical school, felt she needed to be even more perfect. Her breasts were asymmetrical and she had an inverted areola, so she went to an outpatient cosmetic surgery clinic in Boca Raton, Fla., to have what she saw as a problem attended to by doctors.
And now she’s dead.
She died Sunday, 24 hours after undergoing surgery, the victim of an extremely rare reaction to anesthesia called malignant hyperthermia.
Usually genetic and very difficult to detect, the condition causes the body temperature to spike as high as 112 degrees and salts to precipitate out of the blood. If the reaction is not recognized almost immediately and an antidote given, it is fatal.
The death has focused attention on elective breast augmentation surgery, a procedure that 347,500 women of all ages chose to have in 2007 alone. That number is 6 percent higher than in 2006 and 64 percent higher than in 2000.
Although the FDA recommends that only women 18 or older get breast implants, the number of girls under that age submitting themselves to the surgery continues to grow. In 2005, the last year for which full statistics are available, more than 3,500 girls had breast implants.
But Dr. Richard D’Amico, the president of the American Society of Plastic Surgeons, told TODAY’s Matt Lauer on Wednesday that what happened to Kuleba could happen to anyone.
“This young lady’s death is a tragedy. Our hearts go out to her family. It’s a devastating event,” he said. But, he added, “this is something that can happen in any surgery, on any part of the body, in any setting.”
D’Amico encountered it once during what should have been routine nasal surgery on a male patient. He said he was lucky; his anesthesiologist immediately recognized the signs of malignant hyperthermia and took remedial action quickly enough to save the man’s life.
“There’s a medication for this that needs to be given very quickly, which was done,” D’Amico said.
The problem is that there’s no easy way to identify people who are at risk of the syndrome.
“Most often, there isn’t a clue,” he said. “The only test to predict it, you’d have to cut out some muscles from a leg and there’s only five places in the country that can do this.”
Kuleba’s family, who did not wish to be interviewed, has hired an attorney to investigate the death. The doctor who performed the surgery, Dr. Steven Schuster, also declined to comment.
D’Amico repeated the FDA recommendation that no one under 18 undergo breast augmentation surgery. Despite its popularity, the procedure does have a high rate of complications and often requires additional surgery within five to 10 years of the original surgery.
“The development of the breast is a very sensitive issue with young women and very important to them,” D’Amico said.
He recommended that anyone contemplating any cosmetic procedure seek out a board-certified plastic surgeon in a big clinic with a good reputation. But, he warned, as Kuleba’s case so sadly emphasizes, no surgery is completely safe.
“There’s never no risk,” he said. “Our job is to minimize that risk, and we stay up very late to do that.”