One of the nation's largest professional societies for plastic surgeons has issued a statement recommending that its members be more cautious in performing cosmetic breast augmentation in women under age 18.
The statement, issued in late December by the American Society of Plastic Surgeons, is meant to clarify previous policy guidelines that also recommended against implanting the devices in young women, with exceptions, said Philip Haeck, M.D., a member of the ASPS board of directors and a plastic surgeon in private practice in Seattle, Wash.
“This policy had one intent: to clarify a gray area for our members and put into writing what was already issued in previous policies,” Dr. Haeck said.
It also serves as a reminder that saline breast implants are not approved by the Food and Drug Administration for women under 18.
The ASPS acknowledged that there has been an increase in the number of media reports of women younger than 18 getting breast implants for cosmetic reasons. But, said ASPS President Scott Spear, M.D., in a statement, “Contrary to popular belief, people 18 and younger make up only 4% of all cosmetic plastic surgery procedures. Although the numbers have increased over the years, teens continue to be a small percentage of the plastic surgery population.”
According to ASPS statistics, 3,841 women aged 18 or younger had breast augmentation in 2003, a 4% increase over 2000 but a 24% increase over 2002. Another professional group, the American Society for Aesthetic Plastic Surgery, reported that 11,326 women under age 18 had breast augmentation in 2003, accounting for 4% of the 280,401 breast augmentation procedures that year.
Diana Zuckerman, Ph.D., said her Washington, D.C.-based advocacy group, the National Center for Policy Research for Women & Families, asked the ASPS to condemn the procedure in women under 18 in mid-2004, primarily because those women aren't mature enough to make such a decision. A long-time critic of cosmetic breast augmentation, Dr. Zuckerman applauded the new policy statement but questioned whether it gave plastic surgeons a “loophole” by saying implants were acceptable in cases of asymmetry.
Dr. Haeck strongly disagreed with that characterization, noting that asymmetric breasts can be socially and psychologically devastating for young women. “This is a private matter between a surgeon and the patient behind the closed door of an exam room, and it is, just like apple pie, the American way,” he said.
He emphasized, however, that in most instances, cosmetic enhancement would not be acceptable.
“Most of us feel that breast implants for your 16th birthday are inappropriate,” Dr. Haeck said. He did acknowledge that the recommendations were just that—advice. “We can't sit in our members' offices and tell them they can't do it,” he said.
The policy urged a delay in implants for these young women, until they have “sufficient emotional and physical maturity to make an informed decision based on an understanding of the factors involved in this procedure.”
With years of experience, a plastic surgeon can determine whether a young woman has this maturity, Dr. Haeck said, adding that in some cases, it is more obvious when implants would be inappropriate—such as when a boyfriend accompanies the patient and is paying for the surgery.
Michael Olding, M.D., chief of plastic surgery at George Washington University, Washington, and a member of the ASPS's public education committee, said he has never performed cosmetic breast augmentation in a woman under age 18. Some women might be mature at that age, he noted, “but those people are, in my opinion, a very small percentage of the women who would want to have breast augmentation at that age.”