Teen Breast Augmentation: A Matter of Age or Circumstances?
Scott W. Mosser, M.D.
article courtesy Scott W. Mosser, M.D.
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In 2005, only 3,581 patients under age 18 received breast augmentation, representing only about 1% of all breast augmentation surgery performed in the U.S. that year.*
With an increased demand for breast augmentation from women of all ages, I am also seeing an increase in the number of teenagers seeking breast surgery to enhance or alter their breasts.
This may be partly due to the increased acceptance of breast augmentation and its high visibility among teen cultural icons and music celebrities. Also the emphasis MTV and fashion marketing has made on the teen and even pre-teen markets has resulted in pressures on teens to conform to fashionable female body images.
Another reason may be that as breast augmentation surgery has increased there are simply many more mothers of teenage daughters who themselves have undergone breast augmentation with positive results, and want their daughters to have the same benefits.
Breast enhancement has always been a social, emotional, and sexually charged issue, and the question of what age is the right age to consider surgery is perhaps the most delicate issue of all.
Who Should Decide?
Most plastic surgeons and psychologists agree that teen breast augmentation should only be considered when the well being of the teenager is at stake. Adolescent breast augmentation should only be considered in select cases. In such cases, it can dramatically improve a teen's confidence, resulting in a more outgoing personality that in turn opens her world to new possibilities at the most formative time of her life.
I believe the most logical approach is one based on strictly physical imperatives. This includes a thorough medical evaluation of any young woman under 18, including evaluating her mental and emotional health as well as her level of physical health and maturity. Certainly I would only consider modification of breast shape if breast development is complete, with no ongoing increase in breast size in the time leading up to a surgical procedure. Every individual's physical maturity is different, and the age of sexual maturity varies widely between ethnic groups, within ethnic groups and even within families. And emotional maturity does not always keep pace with physical maturity.
Every parent bringing in a daughter - or every daughter under 18 bringing in her parents - should be ready to undergo a full and candid exploration of their reasons for seeking breast augmentation. I will be sure that all the factors involved and the options available are thoroughly discussed and considered before an educated and informed consent is given. Ultimately, the parent (or legal guardian) and I would be responsible for the decision, and it would have to be in the best interests of the minor patient.
What Qualifies as a Good Reason?
Extreme breast asymmetry, for one:
This condition may cause teenage girls undue anguish as they navigate the stormy seas of adolescence and developing body image. Teens with asymmetry often hide it, reporting great embarrassment. It should be noted that mothers seeking to offer solace may downplay a teen's concerns about asymmetry, inadvertently exacerbating the teen's perception of difference and ignoring what may become a significant body image problem.
Furthermore, although acute cases of breast asymmetry may result in a difference of several cup sizes, even milder asymmetries are often very stressful for the teenager. For these reasons, it is vital to identify breast anomalies early in adolescence and pursue treatment in a timely manner if it is deemed appropriate. Scientists have concluded that there is no medical reason to delay necessary treatment until a teen reaches her full physical maturity; experience has shown delaying only serves to prolong the patient's psychological troubles.
Fortunately, breast asymmetry correction is associated with relatively few complications, and patients' reactions to the results tend to be overwhelmingly positive.
Here's how it's done: As soon as a significant discrepancy in breast size is noted, the under-developing breast can be augmented with placement of a tissue expander. The tissue expander remains in place throughout the adolescent's developing years and is periodically inflated to maintain symmetry between the breasts. Once breast development is completed on the opposite side, the tissue expander is removed and a permanent saline implant placed.
Complete physical and sexual maturity
If a thorough examination reveals that full breast growth has been attained and the patient displays an emotional maturity to match her physical maturity, then there is no medical reason to deny breast augmentation if she is not yet 18 years of age. The decision to go ahead would then be made based on the same considerations as anyone else contemplating breast augmentation.
What's the Downside?
Let's say a 16 or 17 year old candidate qualifies on physical and emotional terms. What else should be considered before making this important decision?
The simple fact is that, like adult breast augmentation, teen breast augmentation will not last a lifetime. Most women will require implant replacement at some point, additional doctor visits, a readjustment operation, or removals because of one or more complications, however minor. It is important to note that additional surgery is often needed within 5-10 years of receiving an implant. For such a young adult that timing could easily conflict with education, travel, and job opportunities.
While the parents may foot the medical bills for an initial breast augmentation, future procedures or complications can be expensive for a young adult just starting a career or family, and health insurance rarely covers breast augmentation repair.
Breast feeding of a candidate's future babies may not seem important at 16 or 17, but if the surgical procedure chosen limits or precludes breast feeding, not being able to do so later may become a reason for regret.
Changes in lifestyle, including significant weight lose or gain due to pregnancy, may cause unwanted changes in augmented breasts, and result in losing the confidence in body image previously gained by plastic surgery.
Ongoing clinical studies for unapproved saline-filled and silicone gel-filled breast implants do not allow for those younger than 18 to receive the implants for augmentation purposes. Some of these clinical studies even limit reconstruction and revision uses to women 18 and over.
As with any vital surgery decision, care should be taken to find a reliable and skilled physician, ask all the questions, and carefully weigh the options and possible outcomes of breast augmentation. And, in the case of making such a decision for a minor, special care should be exercised.