Optimal Timing for Reduction Mammaplasty in Adolescents

Laura C. Nuzzi, B.A.; Tannishtha Pramanick, B.A.; Landis R. Walsh, B.A.; Joseph M. Firriolo, M.D.; Gabrielle G. Massey; Amy D. DiVasta, M.D., M.M.Sc.; Brian I. Labow, M.D.


Plast Reconstr Surg. 2020;146(6):1213-1220. 

In This Article

Abstract and Introduction


Background: Reduction mammaplasty effectively alleviates symptoms and restores quality of life. However, operating on adolescents remains controversial, partly because of fear of potential postoperative breast growth. This cross-sectional study provides surgeons with a method to predict the optimal timing, or biological "sweet spot," for reduction mammaplasty to minimize the risk of breast regrowth in adolescents.

Methods: The authors reviewed the medical records of women aged 12 to 21 years who underwent reduction mammaplasty from 2007 to 2019. Collected data included symptomology, perioperative details, and postoperative outcomes.

Results: Four hundred eighty-one subjects were included in analyses and were, on average, 11.9 years old at first menses (menarche) and 17.9 years old at surgery. Six percent of subjects experienced postoperative breast growth. Breast size appears to stabilize considerably later in obese adolescents compared to healthy-weight and overweight patients, and breast growth in obese macromastia patients may not end until 9 years after menarche. Operating on obese women before this time point increased the likelihood of glandular breast regrowth by almost 120 percent (OR, 1.18; 95 percent CI, 1.11 to 1.26). Surgery performed less than 3 years after menarche, the commonly regarded end of puberty, increased the likelihood of glandular regrowth by over 700 percent in healthy-weight and overweight subjects (OR, 7.43; 95 percent CI, 1.37 to 40.41).

Conclusions: Findings suggest that reduction mammaplasty age restrictions imposed by care providers and third-party payors may be arbitrary. Surgical readiness should be determined on an individual basis incorporating the patient's biological and psychological maturity, obesity status, potential for postoperative benefit, and risk tolerance for postoperative breast growth.

Clinical Question/Level of Evidence: Risk, III.


Women with macromastia suffer from considerable musculoskeletal pain, physical limitation, and poor psychosocial well-being compared with their unaffected peers.[1–26] Recent studies have found that reduction mammaplasty in adolescents and young women is a relatively safe procedure that can afford patients significant and sustained physical and psychosocial improvements.[16–26]

Despite the numerous documented benefits associated with reduction mammaplasty,[2–26] some surgeons remain hesitant to operate on adolescents, in part because of a fear of postoperative glandular growth. Often, primary care providers will delay referral and surgeons will postpone surgery until the patient has reached chronologic adulthood. In addition, many third-party payors impose age restrictions when determining coverage for reduction mammaplasty without regard for the patient's psychological and developmental maturity. As such, determining a young woman's surgical readiness relies on insurance and anecdotal metrics, and disregards a potentially more comprehensive, patient-centric measure: biological maturity and, thereby, breast size stability.

The present study's objective was to explore the relationship among the degree of breast hypertrophy, body mass index category, and age at first menses (menarche) in a single-surgeon cohort of young women undergoing bilateral reduction mammaplasty. We also aimed to measure the incidence of postoperative breast growth to present surgeons with a patient-centric method for timing reduction mammaplasty in adolescents to minimize the potential for postoperative breast growth.