With little literature to guide him, Labow set out to study adolescent breast reductions himself. His research, published in Pediatrics in 2012, found that adolescents (defined as girls ages 12-21) with macromastia have decreased quality of life, lower self-esteem, more breast-related pain, and increased risk for eating disorders compared to their peers, even after controlling for body-mass index. (Macromastia is often linked to obesity.)
But many plastic surgeons, pediatricians and parents are hesitant when it comes to breast reductions for teens. For younger girls, one concern is the potential for regrowth. Dr. Julie Park, an assistant professor of surgery and the director of breast reconstruction at the University of Chicago, says she works with pediatric endocrinologists, who use X-rays of growth-plate closures to determine if patients have finished puberty. Growth plates allow adolescent bones to grow and typically close after puberty is complete.
Park recalls a patient whose pediatric endocrinologist documented that at 14, she was finished with puberty and, biologically, no longer an adolescent. Still, because of her age, the patient’s insurance company denied coverage for a breast reduction. When she came back at 18, Park did the operation. “It was life-changing to her, and I saw the difference,” Park says. “When she would see me in the clinic prior to her surgery, she was hunched over, looking down, wearing bulky sweatshirts. And when she came back [for a checkup after her surgery], she was wearing color. She walked in, head up, shoulders back. Just a different person.”
I knew the feeling firsthand: In high school, I usually stuffed myself into a sports bra, sometimes two, to flatten my chest. One time I even duct-taped my breasts apart to spare myself from revealing an obscene amount of cleavage in my prom dress. “Sexuality is such a confusing thing to navigate, even if you don’t stand out,” says Niquie Dworkin, a clinical psychologist based in Chicago. “If you have big breasts, it’s just that much more of this confusing attention.”
Even in situations like mine, though, it’s not uncommon for parents, pediatricians, or insurers of very symptomatic 15- or 16-year-olds to tell them to wait a few more years, Labow says. Growth plates typically close around 12-14 for girls, but when doctors evaluate a young breast-reduction patient, they also look at when she started her period, whether she’s still getting taller, and if her shoe or bra size is still changing, Labow says. “There’s no rule that says as soon as your growth plates close, your breasts don’t grow anymore,” he says.
Because of this, he tells most of his 15-year-old patients that if he makes them a size-C today, they may be a D by the time they graduate college. “Is that a reason to make them wait?” he asks. “It’s the minority of patients that will want surgery again.” While there may be some regrowth, Labow says that it’s unlikely that a patient’s breasts will grow back to their original pre-surgery size. He estimates that, out of his hundreds of teenage patients, only two or three have returned for a second operation.