It is a complicated question that did not have clear-cut answers until recently. Although breast reduction surgery is considered predominantly cosmetic, to the teens who feel they need smaller breasts, it is not merely a procedure for improving appearance. Excessively large breasts can be the result of macromastia, a not uncommon medical condition. Recent research shows that macromastia can wreak havoc on the physical and emotional wellbeing of teens. The most effective treatment for macromastia to date is breast reduction surgery.

Large breasts are considered attractive by a lot of people, and many teens appear to have no problem with them. Some teens with macromastia, however, have a number of challenges to overcome, including the physical and psychosocial issues that accompany the burden of large breasts.

The extent of the problem and the public fascination with large breasts can be seen in the number of Youtube videos that show up in a Google search for the term macromastia. Not many medical conditions result in so many entertainment videos, instead of academic articles and other medical literature. For those who do not cherish triple D cup sizes, large breasts can get in the way of a normal life. This is why breast reduction surgery is not always a cosmetic procedure.

What does research have to say?

Macromastia can have a negative impact on physical and mental health in adult women. Although the condition develops during adolescence, not much research has been done on how macromastia affects the quality of life in teens.

Research on the impact of macromastia on adolescents, published in the August 2012 issue of Pediatrics, the official journal of the American Academy of Pediatrics, found that “Macromastia has a substantial negative impact on health-related quality of life, self-esteem, physical symptoms, and eating behaviours in adolescents with this condition.” The study also found that these observations were independent of the body mass index (BMI) of the participants. That means macromastia is an issue that affects teens regardless of their weight.

In conclusion the researchers stated that “Health care providers should be aware of the important negative health outcomes associated with macromastia and consider early evaluation for adolescents with this condition.” More about this study can be found in an article on the HealthDay website: Large Breasts Can Take Mental, Physical Toll on Teens.

The case for breast reduction

For adult women with macromastia, the surgical reduction of breast size or reduction mammoplasty is the most effective way to improve symptoms and health-related quality of life. However, when it comes to teens, many parents and physicians are reluctant to consider breast reduction surgery. This is why the recent research is important.

Adolescents seek breast reduction surgery because of pain, poor self-esteem and difficulty finding clothes that fit. Scientific evidence shows that women under 30 who have macromastia are troubled by psychosocial consequences such as undesired attention and poor self-image.

Negative attention and harassment can be as emotionally devastating as childhood bullying. For the emotionally vulnerable, such attention can lead to long-term psychological damage. Young adults with macromastia are prone to eating disorders, sometimes at much higher levels than their peers.

Breast reduction surgery can help teens regain self-confidence. It frees them to feel normal again, to be just another teenager, no longer the girl with the big boobs. Breast reduction can take away the unwanted attention and harassment and help them find their way safely through the already fraught teenage years.

Physically, breast reduction gives girls the freedom to engage in sports and activities natural to an active teenage life without pain or discomfort. And most of all, it makes life so much easier when they can find a bra that fits and can wear any teen style clothing without restraint.

Breast reduction surgery has very high rates of satisfaction. The results of a study on the quality of life after breast reduction surgery published in the Annals of Plastic Surgery in October 2012, shows that over 95 percent of the patients surveyed were satisfied with the outcomes and would do it again. The findings also suggest that the size and weight of the patient had no impact on the outcome.

Teens and cosmetic surgery

There is an ongoing dialogue about whether cosmetic surgery should be allowed in teens. “Should plastic surgery have an age restriction?” the Herald Sun asked its readers last March, in a survey that was placed next to an article headed Parents pay for teenage plastic surgery prompting call to ban anyone under 21 from invasive procedures. Of the 635 readers who had taken the survey at time of writing (15 November 2012), roughly 83 percent said yes and 17 percent said no. This is why teens with macromastia who want breast reduction surgery often find it a challenge to get treatment.

The laws of our land leave a lot of discretion in the hands of medical practitioners. And in the absence of specific laws, surgeons are required to resort to the basics of good medical practice that require placing the interests and wellbeing of the child or young person first.

According to an article published in the Australian Family Physician in July 2011, “Considering the rates of cosmetic surgery in comparable Western societies, it seems likely that the number of physicians in Australia who will deal with a request for cosmetic surgery for a child will continue to increase. This is a sensitive issue and it is essential that physicians understand the professional and legal obligations that arise when cosmetic surgery is proposed for a child.”

While the legal framework differs by state and territory, the national framework for cosmetic medical and surgical procedures recently unveiled by the Australian Health Ministers’ Advisory Council defines cosmetic surgery as “a procedure performed to reshape normal structures of the body or to adorn parts of the body, with the aim of improving the consumer’s appearance and self-esteem”. This definition covers common cosmetic procedures performed on children and teens such as ear correction surgery (otoplasty), which is quite often recommended by doctors. However, it also covers other procedures in demand among teens such as nose surgery (rhinoplasty), breast augmentation, breast reduction surgery and liposuction, which are more likely to lead to controversy.

The draft supplementary guidelines on cosmetic medical and surgical procedures for people of any age by the Australian Medical Board covering the national framework states the following pertaining to surgery:

1. If the requested surgery/procedure has no medical justification there must be a ‘cooling off’ period of 3 months, followed by a further consultation during which the request is further explored. The requested surgery/procedure should not be scheduled at the initial consultation.
2. The person should be encouraged to discuss their desire for the surgery/procedure and any concerns with their general practitioner during the cooling off period.
3. The person should be assessed by an appropriately qualified health professional (e.g. psychiatrist, psychologist or specialist counsellor).

Those who oppose cosmetic surgery for the young often say that it encourages unhealthy attitudes and habits merely for the sake of feeling or looking good. But with the research we have highlighted above, teens suffering with macromastia should find it easier to convince their doctors and parents to agree to breast reduction surgery.

Costs of breast reduction surgery are partially covered by Medicare in Australia.

The Costhetics article on breast reduction surgery provides details about this surgical procedure.