This is a controversial issue and every case is handled individually, depending upon the symptoms of the condition and the maturation of the individual. At 13, most teenagers are still in the growing phase, and I would not advise surgery in this age group. First of all, I would suggest that she is evaluated by her pediatrician to rule out other benign causes of macromastia (large breasts). Always try conservative measures first if she is having symptoms such as back pain, neck pain, or limitations on activity from her large breasts. Her appearance will continue to change as she goes through puberty and experiences hormone fluctuations. If the condition persists and she is suffering physical symptoms or issues with self esteem, I would consider consultation at or around age 16, or when she is physically and emotionally mature.

Hayley A. Brown, MD

Breast Reduction

Plastic surgeons should always have the best interest of the patient at heart. Goals of plastic surgery are to improve physical characteristics to enhance natural beauty and quality of life. I feel the best plastic surgery is when it doesn't look like you've had a procedure. Too much plastic surgery tends to look unnatural and can make you look older than your stated age, distorting your features. It is our responsibility to say "no" to patients who have unrealistic expectations, or to patients who lose the perception of reality after reaping physical and emotional benefits of previous procedures and "want more".

We have an ethical and moral responsibility to take care of our patients and guide them into making realistic decisions about procedures. We also have to think about long-term consequences of repeated operations and uncorrectable deformities that can occur when too many procedures are performed. So yes, we should always interfere and turn away patients who go too far with cosmetic surgery.

H. A. Brown, MD

Miscellaneous