Breast augmentation surgery is one of the most common cosmetic surgical procedures and patients are not usually in their teenage years. There is a “too young” for this procedure which may vary from patient to patient. That being said, the most important aspect of choosing a patient for breast augmentation surgery is finding a patient who has completed their sexual development. It is essential that a woman’s breasts have reached their maximal development prior to proceeding with the preparation for the operation. Otherwise, a surgeon is operating on a moving target and what may be appropriate today, maybe malpositioned a year from now. Also, choosing the proper implant size should be based on the patient’s native and stable breast volume.
Some young women suffer from true medical conditions such as Poland's syndrome, a significant breast asymmetry where one breast is substantially larger than the other (e.g. A versus D), and even juvenile breast hypertrophy. In these circumstances, each patient needs to be considered individually as there are too many variables to set specific guidelines. These medical conditions fall outside the realm of a routine breast augmentation procedure.
It is important for the patient to be emotionally mature as well. Surgery is a stress and patients who elect to undergo the procedure need to be willing and able to accept the discomfort that is expected with this operation. A successful procedure is dependent on a patient who is prepared to tolerate the expected recovery from the operation. Occasionally, teens are less willing or adept at handling the additional stress or pain associated with the operation. In teens, significant family support is mandatory to proceed with a breast augmentation surgery.
With the FDA’s approval of silicone implants in 2006, one of the requirements was that the implants were only for 22 years of age and older patients. Patients from the teenage years until 21 are allowed for saline implants only. Since there is no fundamental change that occurs in a woman’s body at the age of 22, we do not feel that this is scientifically based and thus somewhat arbitrary.
Saline implants are an inferior device to the silicone counterparts for a number of reasons. Saline implants have a much higher incidence of visible rippling, feel firmer and have a less natural result. Most women want a result that enhances their breast size in a manner that seems to be realistic and natural. Saline, unfortunately, produces a more “augmented” and fake look in comparison with silicone.
This FDA restriction limits the choices of those patients under 22 years old. As physicians, we have the ability to use FDA approved medical devices in a manner called “off-label use.” This allows surgeons to use silicone implants in a similar manner to their original approval, but in an arena where there was no original approval by the FDA. This allows plastic surgeons to legally use silicone devices in patients under 22 with the caveat that this is discussed with the patient in detail.
There are no specific increased risks associated with surgery at a younger age. As long as patients are healthy and without significant medical problems, they should be well poised to undergo the surgery.
Finally, we feel that patients at least 18 years of age or older should be good candidates for breast augmentation and we routinely use silicone implants off-label in patients 18-21 years of age. Most young women have reached their peak growth and development by this age and should have achieved their maximal breast size. Assuming the patients are mature and have the support of their family, our cut off is at 18 years of age. It is important to ensure that you meet with a Board Certified Plastic Surgeon to get a formal opinion after an in-person evaluation.
