Clearly this is a very complex and difficult question, and as varied and complicated as every single individual teen that is out there…

As a plastic surgeon and a Mother of 3 young adults, 20, 18, and 15, I have significant professional as well as personal experience with this topic. I am very sensitive about this subject given the fact that my 18 and 15 year olds are young independent headstrong women.

I have so many young teenagers and young adults, boys, and primarily girls that inquire about rhinoplasty and breast and body contouring. Often times, the Mother will bring the patient into my office or if the patient is 18 years or older, they themselves make the appointment, pay the consultation fee and attend the consultation alone or with a friend.

Perhaps more at issue is what is the nature of the plastic surgery inquiry. There are many procedures that truly will enhance the self confidence of the teenager that corrects a genetic predisposition, for example, gynecomastia, in young men.

Some male adolescents develop breasts secondary to rapid weight gain, hormones, and genetics. This can be extremely debilitating for the teenager. He refuses to be seen without a shirt on during PE, any sports activity, and then continues to gain weight thereby worsening the amount of actual breast tissue and fat.

Liposuction for gynecomastia in the young adolescent male can be life changing and extremely uplifting. Breast augmentation for the young adolescent girl, however, absolutely projects a different image. While you could make an argument that liposuction for gynecomastia is a necessity like obesity surgery, you would be hard pressed to say breast augmentation is a necessity because it corrects a genetic abnormality. But truthfully, it does.

So what’s the difference? Again, as a Mother of 2 young adolescent women AND a plastic surgeon, I am always torn as to what is the right answer. The truth is, it is completely dependent on the young woman and her parents if they are paying for it. However, after the age of 18, the young woman has total legal rights to sign her own surgical consent and undergo any procedure. So why am I so torn about the issue of breast implants for a 16 or 17 year old.

So why does it seem so wrong for a 16 or even a 17 year old to ask and want a breast augmentation? First of all, call me naive and ignorant, but I still feel that while they are physically ready to have sex, which is what breast enhancement implies, I think they are still too emotionally immature and do not need yet another complex issue to bring drama and angst into an already too tumultuous life. Yes, of course, the teen may be motivated by lack of confidence and self esteem (which is more perhaps the case when there is severe breast asymmetry) but really the teen is saying I am ready or have already been engaging in sexual activities and now want a breast augmentation.

First of all, the recommendation of the Association of Plastic Surgeons is to wait until the age of 18 for saline implants and the age of 23 for silicone implants. That being said, it is still the decision of the parent to allow this to occur and up to the plastic surgeon to discuss all of the legal and medical risks and implications.

This is when I discuss with the patient and the parent if they are involved, the long term implications of a breast implant, the surgical effect on the breasts, the implications for future mammograms, breast cancer, breast feeding etc, etc, but MOST IMPORTANT of all, I personally assess the emotional stability and psychological maturity of the patient and her relationship with the parents and/or boyfriend.

I then make a recommendation depending on my assessment of the patient, the situation, and what the parent has expressed to me. Oftentimes, the parents have called me first to discuss this consultation prior to the actual surgical consultation and they express their true wishes without their daughter in attendance because they don’t want to say no to the daughter who would then become belligerent, nasty, and relentless. The parents are actually asking me for help to say no to their daughter. The parents want me to guide the daughter into making the decision to wait until she is 18.

I believe that is a reasonable request and I ask the patient to return in 6 months or a year or a set amount of time to discuss the surgery (which I would normally for any patient) but in this case even more important as the passage of time may see the patient turn 18 as well as give her time to think about the surgery and its implications.

My personal advice to parents who are extremely against any plastic surgery for their teen before the age of 18…is you hold the pocket book, you make the decision. More than likely your teenager does not have the resources to pay for the surgery and you have the ultimate power and authority (finacially and legally) so don’t give in until YOU are comfortable with it or until they are 18 and whatever age it is when you feel they are making sound choices.

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