In light of growing requests from adolescents for cosmetic breast and vulvar surgery, the American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion that appears online April 21 and in the May issue of Obstetrics & Gynecology.
ACOG noted that obstetrician-gynecologists are uniquely positioned to screen and counsel adolescents concerned about the appearance of their breasts and external genitalia. "This age group may be under particular stress regarding these issues because of societal conceptions of the ideal female body and parental concerns for body perfection," writes the ACOG committee, chaired by Julie Strickland, MD, MPH, an obstetrician-gynecologist based in Kansas City, Missouri.
The profession must therefore be well-informed about normal sexual development, normal differences in appearance of the breast and genitalia, nonsurgical treatment options, and autonomous patient decision-making. "Variety in the shape, size, appearance and symmetry of labia can have particularly distressing psychological effects on young women," said Dr Strickland in an ACOG news release. "It's one more body part that women are insecure about and it's our job, as ob-gyns, to reassure our young patients."
According to the American Society of Plastic Surgeons, 2010 saw more than 4600 surgeries for breast reduction in girls and young women aged 13 to 19 years. And in 2013, in excess of 8200 breast augmentations were performed on women in the 18- to 19-year age category.
Although concern with the appearance of the external genitalia is on the rise, there is no established consensus on the definition of labial hypertrophy or criteria for surgical intervention, the statement noted. Furthermore, cosmetic vaginal procedures are not medically indicated, and their safety and efficacy remain unproven. More information on these interventions can be found in ACOG's 2007 committee opinion on "Vaginal 'Rejuvenation' and Cosmetic Vaginal Procedures."
The best starting point in treating adolescents seeking surgical enhancement is often education and reassurance. "It's important for ob-gyns to discuss sexual development and the variability of what breasts and genitalia may look like," Dr Strickland said in the news release.
It is also critical to assess patients' capacity to make their own decisions autonomously, without pressure from family or peers, the statement added, noting that patient-initiated surgeries tend to have more favorable outcomes than those urged by family members.
Clinicians also need to evaluate whether adolescents seeking surgical enhancement have realistic expectations of the outcomes.
ACOG's four main recommendations for obstetrician-gynecologists treating these adolescents enhancement are:
Clinicians should acquire a good working knowledge of nonsurgical options and indications for surgical management.
Adolescents need to be educated about normal differences in anatomy, growth, and development of breasts and genitalia.
Before surgical referral, patients should have appropriate counseling and assessment of their physical and emotional maturity.
Physicians should screen for body dysmorphic disorder, and when they suspect its presence, which can result in repeated unsatisfactory surgical corrections, they should refer patients to mental health professionals.
According to the American Society for Aesthetic Plastic Surgery, labiaplasties in general were up by 16% in the United States in 2015, and in the United Kingdom, rising concerns about genital surgeries led the Royal College of Obstetricians and Gynaecologists and the British Society for Paediatric and Adolescent Gynecology to issue recommendations about adolescent labiaplasty in 2013.
Obstet Gynecol. 2016:127:e138-e140. Full text
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Cite this: ACOG Releases Statement on Breast, Genital Surgery in Teens - Medscape - Apr 22, 2016.
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