07/08/2010

Dear Patti,
My daughter, Genève, is a fully developed 16-year-old but is extremely flat-chested. Several months ago, some girlfriends gave her a gift of a lacy bra. She was thrilled when it fit, only to find out — amid the girls’ laughter — that they’d cut the centers out of both brassiere cups and sewn them up so they’d fit her. She was devastatingly humiliated. I felt so sorry for her and so mad at those girls! She’s now obsessed with having breast augmentation surgery. Her father thinks she should wait until she’s 18, but Genève thinks it’s very cruel of us to keep her “disfigured” until after high school. It hurts me to see her act so ashamed, and I’m worried she’ll always hold it against us if we make her wait for two years. I’m not sure if we should allow surgery or not. What’s your advice? —Billie

Dear Billie,
I think many people — including the American Society of Plastic Surgeons — would be inclined to agree that Genève is way too young to make such a permanent decision. At 16, and in the normal throes of teenage angst and impatience, her sense of self is not only just beginning to develop but will likely change many times until she reaches her late 20s. Conversely, it’s important to be careful of prejudice just because it’s about her breasts. If her ears, jaw or nose had grown in such a way that she felt deformed and was laughed at by others, would you ask her to wait until 18 to pursue surgical repair?
 
Is Genève truly malformed or within a normal range but simply small? Many plastic surgeons only treat teens with extreme breast asymmetries or a severe lack of breast tissue, not just because girls may want to go from a “B” to a “C” cup. In cases of true necessity, there’s the mental health benefit of a self-confidence boost and a noticeable improvement in a teen’s overall mood. It should further be considered, however, that breast development can continue into the late teens and early 20s. Accordingly, there’s a chance her figure might change naturally in the next few years, while her body is still maturing. 
 
Have the three of you been clearly advised on the risks associated with this surgery? Along with breast pain, hardness and numbness that may last for years or permanently, there’s a high complication rate that often requires additional surgeries. Breast implants can also interfere with mammography and obscure breast tumors. 
 
Seek medical information and recommendations of several doctors, internists and gynecologists. Obtain referrals to three or four plastic surgeons within different referral circles. Get professional opinions concerning how she’ll be affected physically during this developmental stage. Psychologically, I’d recommend at least three months of counseling prior to any surgery to make sure this decision doesn’t stem from past social traumas or an underdeveloped ability to love and accept herself and her body. I’ve worked with many a client who has still felt ugly inside, despite cosmetic surgery enhancement, because they hadn’t addressed and healed from the emotional reasons behind negative perceptions of themselves.
 
In reviewing what course to take, it’s critical your decision not be based on whether she’s going to stay upset with you. Yes, 10 years from now she may be angry that making her wait caused her unnecessary social and psychological trauma. She could also just as easily be angry that you soft-pedaled your parental role by letting her make a decision herself when she was too young to anticipate the consequences. There’s no way to know how things might turn out or how she might feel in the future. The best you can do is acquire the facts necessary to make an informed, safe choice and to seriously review Genève’s maturity, psychological and physical states.