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Breast Surgery in Adolescents: When Should You Consider It?

Breast Surgery in Adolescents: When Should You Consider It? 150 150 Ibrahim Khansa, MD

Research shows that addressing macromastia, breast asymmetry and gynecomastia in adolescence can improve physical symptoms as well as quality of life and mental wellbeing.

Breast disorders such as macromastia, breast asymmetry and gynecomastia are in adolescents.2 Those conditions can negatively impair quality-of-life, and their surgical treatment has been shown to improve self-esteem, as well as physical and mental wellbeing. We also know that addressing these conditions during adolescent years can capitalize on these improvements. Teens with breast disorders may not need to wait until they are 18 for surgical correction.

Breast Reduction

Macromastia is the benign enlargement of one or both breasts in a female. Patients with macromastia may suffer pain in their back, shoulders and neck. These symptoms often prevent patients from participating in sports, or even activities of daily living. Symptomatic macromastia has been shown to negatively impact quality-of-life1 and self-esteem.4

Reduction mammaplasty, sometimes called breast reduction surgery, is a surgical procedure that is used to correct symptomatic macromastia. Reduction mammaplasty has been shown to improve quality-of-life, self-esteem and physical wellbeing in teenagers with symptomatic macromastia. Using the validated Breast-Q questionnaire, a 2021 study in Plastic and Reconstructive Surgery found that women who underwent breast reduction had significant improvement in quality of life after surgery.2 Similarly, a 2019 study from the same journal found improved quality of life in women 25 years of age and younger.3 Numerous other studies have shown improved quality-of-life, using instruments such as the Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and Eating-Attitudes Test-26.4, 5

Adolescents do not need to wait until they are 18 years old to undergo reduction mammaplasty. In order to minimize the risk of breast regrowth after surgery, reduction mammaplasty is usually considered once breast size has been stable for at least 12 months. This usually occurs approximately 3 years after the onset of menarche.6

Addressing Asymmetry

Similar to macromastia, breast asymmetry has been shown to have negative effects on quality-of-life.7 In a 2019 study of 59 adolescents with breast asymmetry and 142 controls, researchers found that teenagers with breast asymmetry had significantly lower quality-of-life and self-esteem.7

Surgery to correct breast asymmetry varies depending on the type and cause of asymmetry. It may involve reshaping the breasts, augmenting the smaller breast, reducing the larger breast, or a combination of these procedures. Correction of breast asymmetry has been shown to significantly improve quality-of-life and self-esteem in adolescents.8

Breast Surgery in Males

In male adolescents, gynecomastia refers to persistent abnormal breast enlargement. While gynecomastia occurs in more than 50% of adolescent males, it often resolves spontaneously. In the 8% of cases where it persists beyond 12 months,9 it becomes unlikely to resolve, and surgical treatment should be considered. Before embarking on surgery, a full history and physical examination are necessary to differentiate idiopathic gynecomastia from pathologic gynecomastia, which may be related to medications, illicit drug use, tumors or chromosomal abnormalities. Gynecomastia can have significant negative impacts on self-esteem and quality of life,9 and surgery to correct gynecomastia has been shown to significantly improve quality-of-life and body image.10

Multidisciplinary Care for the Best Results

Adolescence can be a psychologically challenging time, and disorders of the breasts can significantly exacerbate those challenges. At Nationwide Children’s Hospital, the Adolescent Breast Program, which includes plastic surgeons, psychologists and endocrinologists, takes a holistic approach to the care of adolescents with breast disorders, with the goal of optimizing satisfaction and quality of life.

 

References:

  1. Cerrato F, Webb ML, Rosen H, Nuzzi L, McCarty ER, DiVasta AD, Greene AK, Labow BI. The impact of macromastia on adolescents: a cross-sectional study. Pediatrics. 2012;130(2):e339-346.
  2. Elfanagely O, Othman S, Rios-Diaz AJ, Cunning JR, Whitely C, Butler P, Fischer JP. A Matched Comparison of the Benefits of Breast Reduction on Health-Related Quality of Life. Plast Reconstr Surg 2021;148(4):729-735.
  3. Krucoff KB, Carlson AR, Shammas RL, Mundy LR, Lee HJ, Georgiade GS. Breast-Related Quality of Life in Young Reduction Mammaplasty Patients: A Long-Term Follow-Up Using the BREAST-Q. Plast Reconstr Surg. 2019;144(5):743e-750e
  4. Nuzzi LC, Firriolo JM, Pike CM, DiVasta AD, Labow BI. Complications and Quality of Life following Reduction Mammaplasty in Adolescents and Young Women. Plast Reconstr Surg. 2019;144(3):572-581.
  5. Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, Webb ML, Faulkner HR, DiVasta AD, Labow BI. The Effect of Reduction Mammaplasty on Quality of Life in Adolescents With Macromastia. Pediatrics. 2017;140(5):e20171103.
  6. Nuzzi LC, Pramanick T, Walsh LR, Firriolo JM, Massey GG, DiVasta AD, Labow BI. Optimal Timing for Reduction Mammaplasty in Adolescents. Plast Reconstr Surg. 2020;146(6):1213-1220.
  7. Nuzzi LC, Cerrato FE, Webb ML, Faulkner HR, Walsh EM, DiVasta AD, Greene AK, Labow BI. Psychological impact of breast asymmetry on adolescents: a prospective cohort study. Plast Reconstr Surg. 2014;134(6):1116-1123.
  8. Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, DiVasta AD, Labow BI. The Effect of Surgical Treatment on the Quality of Life of Young Women with Breast Asymmetry: A Longitudinal, Cohort Study. Plast Reconstr Surg. 2020 Oct;146(4):400e-408e
  9. Nuzzi LC, Cerrato FE, Erikson CR, Webb ML, Rosen H, Walsh EM, DiVasta AD, Greene AK, Labow BI. Psychosocial impact of adolescent gynecomastia: a prospective case-control study. Plast Reconstr Surg. 2013;131(4):890-896.
  10. Nuzzi LC, Firriolo JM, Pike CM, Cerrato FE, DiVasta AD, Labow BI. The Effect of Surgical Treatment for Gynecomastia on Quality of Life in Adolescents. J Adolesc Health. 2018;63(6):759-765.

About the author

Ibrahim Khansa, MD, FAAP, is a surgeon in the Department Plastic and Reconstructive Surgery at Nationwide Children's Hospital and clinical assistant professor of Plastic Surgery at The Ohio State University College of Medicine. He is the co-director of the Hemangioma and Vascular Malformations program and member of the Center for Complex Craniofacial Disorders and the Cleft Lip and Palate Team. Dr. Khansa received his medical degree from Harvard Medical School. He completed a plastic and reconstructive surgery residency at The Ohio State University Wexner Medical Center, followed by a pediatric craniofacial fellowship at Children’s Hospital Los Angeles.

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