Surgery For Adolescents
Any surgery on adolescents should be considered very carefully and this is particularly important for ‘non-essential’ surgery. Plastic surgery of a reconstructive nature, performed on children, is well accepted. Cleft lip, cleft palate, hand deformities, burns and trauma fall in this category.
Procedures that address teasing or obvious differences are also more accepted, for example prominent ears or significant difference in ear size, shape or folding.
Surgery on adolescents’ breasts is less accepted but may be warranted. Very large breasts (in relation to body size not just absolute size) can result in teasing, restrict sport or exercise and influence posture. Neck, shoulder, breast and back pain can result. Significant asymmetry can limit exercise (swimming, gym) and make the buying of bras very difficult and influence self-esteem.
What is difficult in an assessment is trying to take in to account subsequent growth and development. Growth charts show the average women will gain weight between 18 and 21 years of age. This fat may not have equal distribution and may influence breast size or shape, hips and thighs. With subsequent growth, some teenagers may require revision of their breast surgery, especially breast reduction surgery.
Body dysmorphic disorder is always a common concern for surgeons in regards to adolescents. A useful reminder is beware of ‘SIMON’ seeking rhinoplasty - that is a Single, Immature Male who is Overly Narcissistic. These people are unlikely to ever be happy with the result of surgery.
Television makeover shows that condense major plastic surgery with additional hair styling, teeth correction and professional make-up only help to make expectations less realistic. Surgeons themselves may also play a role in this misconception, as it is very unusual to find less than favourable before and after results on their webpages.
It is never possible to always make the correct decision but a pragmatic approach helps. The surgery should be initiated by the adolescent - not the boy or girlfriend or parent. Parents should be aware, supportive and involved and attend the consultations.
Referral from the adolescent’s usual General Practitioner that includes a full history rather than a generic referral from a medical centre is helpful. Considerations of complications and adverse outcomes is required. Plus, the cost is not only in dollars but also in time, recovery and impact on family and schooling. Assessment of both physical and emotional maturity is important.
Different states in Australia have different guidelines and so this does not make the process any easier. A minimum would be a three-month cooling-off period, a second consultation, and preferably a review by a second plastic surgeon. Queensland may imprison practitioners who operate on children without good reason. Victoria suggests that persons under 18 should be mature enough to give informed consent. The Medical Council of New South Wales suggests a three-month cooling-off period. Many rules however are quite vague.
Careful assessment, a thorough history, parental involvement, general practitioner involvement, appropriate timing, a second consultation and secondary review will be helpful in planning the best action for the younger patient.
DR KIPPEN CREDIT