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Is There a Role for Adolescent Breast Augmentation?

Rod J. Rohrich, MD; Edward M. Reece, MD

Female breast augmentation has increased in popularity as judged by an increase in the number of procedures over the last several years by board certified plastic surgeons.1 The recent reintroduction of silicone breast prostheses has no doubt played a role in the increased interest in cosmetic primary breast augmentation.2 Interest alone does not make a patient an ideal candidate for any type of surgery. Few plastic surgeons would argue with the premise that patient selection is the foundation for optimal results especially when considering cosmetic surgery. Limitations on potential candidates clearly involve age.

The American Society of Plastic Surgeons (ASPS) suggests guidelines discouraging cosmetic breast augmentation in women younger than 18 years without thoughtful and thorough discussion with the patient and her family.1 The FDA goes much further, clearly declaring that breast augmentation before 18 years should not be done.1 There are many reasons for these recommendations and practitioners must be aware when they are approached by adolescents concerning breast augmentation.

Augmentation mammoplasty often necessitates implant exchange after as little as 8 years.3 This applies to both saline and silicone breast implants. An adolescent undergoing augmentation will therefore likely be subjected to multiple implant exchanges over her lifetime. Another reason is that studies of the psychological outcomes on breast augmentation patients may have a significant impact when considering adolescent patients.4 Finally, from a purely common sense point of view, implant placement for cosmetic purposes in a patient who may not have reached developmental maturity is simply not prudent.

Implants are not universally to be condemned in adolescent patients, however. Indications for saline or silicone implants in a patient younger than 18 may include congenital breast deformities such as Poland Syndrome, constricted breasts, and tuberous breasts.5-8 Other subgroups of patients that should be considered for augmentation in their teens are patients with significant congenital breast asymmetry and other acquired severe breast deformities. Individual plastic surgeons approaching the adolescent cosmetic augmentation patient should make an informed decision with the patient and the family, who both need to be involved in the process.

Consultation with a prospective patient and her family must include data about silicone and saline implants. Specifically, saline implants have a decreased capsular contracture rate and rupture rate compared to silicone breast implants.9,10 Silicone implants require a larger incision for placement then saline implants.2 Rupture detection for silicone implants depends on MRI which is recommended to be performed periodically and likely will not be reimbursed by insurance. Saline implant rupture can be detected by the health care provider and patient.3

Primary breast augmentation surgery, as mentioned earlier, is not an isolated operation and both saline and silicone implants will need replacement by repeat surgery. The exchange is easier with saline compared with silicone gel implants. Patient satisfaction is high with both types of implants.11,12 The cost of saline implants is roughly half the cost of silicone gel implants. Both types of breast implants reduce detection of breast cancer by standard mammography and require additional views to adequately image the breast. Although placement of either breast implant reduces detection capability of breast cancer, breast augmentation patients have the same survival outcomes as non-augmented women following treatment.13

In conclusion, breast augmentation in the adolescent patient should be limited to those patients with specific developmental or syndromes or conditions, and patients with significant breast asymmetry whether acquired or congenital. In general, cosmetic breast augmentation should not be performed in patients younger than 18 years for the reasons delineated. Finally, if augmentation is planned for reconstructive purposes, a full informed consent with both the adolescent and her parents must be performed with complete disclosure of known complications.

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Rod J. Rohrich, MD, is Professor and Chairman, Department of Plastic Surgery at UT Southwestern Medical Center, Crystal Charity Ball Distinguished Chair in Plastic Surgery, and Better and Warren Woodward Chair in Plastic and Reconstructive Surgery. Edward M. Reece, MD, MS, is Chief Resident, Department of Plastic Surgery. Both are at the University of Texas Southwestern Medical Center, Dallas, TX.

References

1. Rohrich RJ, Cunningham BL, Jewell ML, Spear SL. Teenage breast augmentation: validating outcome data and statistics in plastic surgery. Plast Reconstr Surg. 2005;115(3):943-944.
2. Rohrich, RJ, Reece E. Breast Augmentation Today: Saline vs Silicone, what are the facts? Plast Reconstr Surg. In Press.
3. Héden P, Nava MB, van Tetering JP, et al. Prevalence of rupture in inamed silicone breast implants. Plast Reconstr Surg. 2006;118(2): 303-312.
4. Rohrich RJ, Adams WP Jr, Potter JK. A review of psychological outcomes and suicide in aesthetic breast augmentation. Plast Reconstr Surg. 2007; 119(1): 401-408.
5. Toranto IR. Two-stage correction of tuberous breasts. Plast Reconstr Surg. 1981;67(5): 642-646. von Heimburg D, Exner K, Kruft S, Lemperle G. The tuberous breast deformity: classification and treatment. Br J Plast Surg. 1996;49(6): 339-345.
6. von Heimburg D, Exner K, Kruft S, Lemperle G. The tuberous breast deformity: classification and treatment. Br J Plast Surg. 1996;49(6): 339-345.
7. Gatti JE. Poland’s deformity reconstructions with a customized, extrasoft silicone prosthesis. Ann Plast Surg. 1997;39(2):122-130.
8. Hodgkinson DJ. The management of anterior chest wall deformity in patients presenting for breast augmentation. Plast Reconstr Surg. 2002; 109(5):1714-1723.
9. Fiala TG., Lee WP, May JW Jr. Augmentation mammoplasty: results of a patient survey. Ann Plast Surg. 1993; 30(6):503-509.
10. Cunningham BL, Lokeh A, Gutowski KA. Saline-filled breast implant safety and efficacy: a multicenter retrospective review. Plast Reconstr Surg. 2000;105(6):2143-2150.
11. Héden P, Boné B, Murphy DK, Slicton A, Walker PS. Style 410 cohesive silicone breast implants: safety and effectiveness at 5 to 9 years after implantation. Plast Reconstr Surg. 2006;118(6): 1281-1287.
12. Inamed-Corporation. The Large Simple Trial (LST). 2002.
13. Skinner KA, Silberman H, Dougherty W, et al. Breast cancer after augmentation mammoplasty. Ann Surg Oncol. 2001;8(2):138-144.