"I Want Surgery Now!"
What teens and parents need to know about breast surgery
By Eric Sparling
Maybe you're a mother who's heartbroken about your 16-year old daughter being ridiculed for her "flat" chest. Or perhaps you're an active young woman who's sick of her large bust interfering with her favorite sport. Well, unhappiness about breast size and appearance is common among teenagers. But when does unhappiness warrant a surgical solution, and how young is too young?
Dr. Joao Carlos Sampaio Goes is a past president of the International Society of Aesthetic Plastic Surgery (ISAPS), and the scientific director of the Brazil-based Instituto Brasileiro de Controle do Cancer (IBCC).
"There is no specific age for mammoplasty," says Goes. "We should base our decision in every specific case by consider the body's development and how big the problem is for the patient."
Whether it's a mammoplasty (reduction) or enlargement (implants), Goes stresses the importance of using a "conservative" approach. In the case of augmentation, for example, he would only recommend it for young women who have "very, very small breasts." And for such surgeries he uses the inframammary fold method – to preserve nipple sensation – won't use large implants, and inserts the implants sub-fascially (which is less invasive than having it placed beneath the chest muscles).
Dr. Foad Nahai is currently the First Vice-President of ISAPS, and a director of the American Board of Plastic Surgery. The Atlanta-based surgeon sets his lower age limit for implants at 18. "Of course, I would only use a saline implant," he says.
He says 16 or 17 is the "usual age" for reductions. "Ideally, they should only undergo reduction once the breast has stopped enlarging in size," although there are circumstances that warrant reduction before growth is complete.
Both physicians stress that surgery is not without risks, both psychological and physical. Surgery can leave scars and may effect breast sensation and even the ability to breast feed in the future. Dr. Nahai emphasizes that, in the case of implants, young women need to be "mature enough to understand that these are not permanent devices, they are not maintenance free, and it will take a lifetime of commitment to maintain their result." The doctors are in agreement that an implant needs to fit the patient's body: "Someone with a narrow chest and a narrow breast may not be able to accommodate the dimensions of a large implant," says Goes.
After mentioning all of these reservations, it's important to stress that there are conditions under which these surgeons would recommend procedures. Over-sized breasts, in particular, can have a negative impact on health. Some of the conditions the doctors cite include back pain, neck and shoulder pain, and intertrigo (infection under the fold of the breast). Undersized breasts do not carry the same health implications as oversized breasts. In the case of the former, psychological issues will be the primary consideration.
The question remains: surgery or no surgery? Well, in the case of teenagers getting reductions or implants, caution seems to be the watch-word. Ideally, a girl should wait until she has passed fully through puberty before undergoing a procedure (although there are exceptions). And neither physician cited physical reasons why implants would be necessary.
Enlargement is always a cosmetic procedure; while psychological trauma is real and painful, a self-esteem-based, counseling approach might be worth trying before seriously considering a physical solution.