• Breast Augmentation. Only a small minority of breast augmentation procedures, 1.5%, were performed in patients 18 years and younger in 2011. "Young women seek breast implants because their breasts look odd; it is not necessarily size that is driving it, but almost always the shape," Dr. McGrath said.
Approximately 25% of patients having breast augmentation have a reoperation within 10 years. "That is the number to know," Dr. McGrath said. "Is the likelihood of additional surgery acceptable to the patient?"
Silicone breast implants are not FDA cleared for breast reconstruction in females younger than 22 years. Therefore, only saline implants are an option in these younger patients, Dr. McGrath said. An advantage of saline implants is they can be inserted through a small incision and then filled, which is not possible with silicone gel implants.
Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. However, "the problems due to the implantable device are the real issues," Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become malpositioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.
Consultation with a qualified plastic surgeon who can focus on long-term implications is warranted, Dr. McGrath said.
• Breast Reduction. Defer surgery until full breast maturation and growth is achieved. Breast size should be stable with no continuing growth for 9-12 months, Dr. McGrath said.
Smoking, obesity, medical conditions that impair wound healing, bleeding disorders, or a body mass index greater than 30 kg/m2 are contraindications. "Some obese women have large breasts, and many are disappointed when I tell them they should defer breast reduction until after weight loss."
Another point to counsel patients about is that lactation is not always possible after breast reduction. "I have had young women walk away from this and say, ‘It’s very important for me to breast feed my baby someday.’"
• Liposuction. The American Society of Plastic Surgeons cautions that liposuction and tummy tucks are inappropriate procedures for weight loss in teens, Dr. McGrath said. "I cannot tell you how many obese teens get referred to me for liposuction. I have to tell them it’s not the right thing ... and it will not correct your basic problem."
In contrast, lipoplasty, liposculpture, or liposuction to treat localized fat deposits can be indicated in some teenagers. "The ideal patient is at or near ideal body weight with elastic skin that will retract."
"Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic," Dr. McGrath said. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.
• Gynecomastia. About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. "The distinction between what is gynecomastia and fat tissue gets murky in overweight patients," Dr. McGrath said.
Gynecomastia can be self-limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because "it is a source of embarrassment. Like our young women, it’s not so much the size, it’s the odd look of a protuberant breast on a male."
"The central issue with any elective plastic surgery is not the presence or absence of disease, rather the effect of the problem on the person," Dr. McGrath said. "It comes down to quality of life, and whether or not you believe improving quality of life is part of our job."
Dr. McGrath recommended the American Society for Aesthetic Plastic Surgery guidelines for evaluating teenagers considering cosmetic plastic surgery.
Dr. McGrath said she had no relevant financial disclosures.