This is an issue which comes up with great regularity, and it is very unfortunate to me. I think because ot things that have nothing whatsoever to do with medical science and logic, like politics and bureauocratic manipulation and corporate finances, we have marginalized a group of patients, like yourself, who we otherwise believe are acceptable candidates for breast augmentation surgery. And, sadly to me, we have forced them to accept a singular option for implants, namely saline implants, which I think I can actually make a sound argument are not as "safe" as currently available silicone gel filled implants. While there is no dispute about the safety of saline as a fill material - it is IV fluid after all, and it will cause no injury or illness. But, based on available medical studies, extensive studies no less, we also believe that silicone gel is safe that way too. There are no diseases or illnesses directly attributable to silicone gel. However, saline implants are known to rupture significantly more frequently than silicone implants, they are much more likely to ripple, especially in thinner, younger patients, they are more likely to produce unsatisfactory aesthetic issues like palpability and unnatural feel, and all of these things, in my experience, have resulted in increased need to return to the OR for saline implants. I don't solicit any patients with saline implants to do anything to their implants if they aren't ruptured or causing problems, but the fact of the matter is that collectively, for ruptures and all of the otehr reasons I noted above, I have been much more likely to returen to the OR for patients with saline implants than silicone gel implants. To me this is a statistical "safety factor," and I have always believed it should be factored into the decision of whether or not to use saline implants. The only problem is that for you young ladies who are not yet 22 years old, you're almost being forced by circumstances, non-medical at that, to accept the arguably "riskier" option. The fact of the matter is that I don't know anyone who has determined that something magical happens to a young lady's breasts when she turns 22 years old that suddenly makes them safe for silicone whereas before that age they weren't. And if it's just an issue that the breasts aren't mature enough in the first place to get implants, then why are we even offering saline? We should make the minimum age for all breast augmentation 22 years old. In truth, what happened was way before you were born there was a huge hysteria surrounding silicone gel implants. Many people thought they were causing all kinds of diseases, and the FDA reacted in a knee-jerk fashion and restricted all silicone gel filled implants in the US for all ages; only certain cases, like cancer reconstructions, could use silicone implants. This went on for almost 20 years until in 2006 the FDA's committee, which included doctors with little to no understanding of silicone gel implants and non-medical bureaucrats, finally determined that the implants were safe based upon the available, very voluminous studies. And we continued to collect even more data for another 10 years, and those studies also showed no health risks. The problem was that the implant companies, at the time Mentor and Allergan only, had only done their studies on ladies over the age of 21. Therefore, the FDA had no basis for approval of the implants for use in anyone outside of those age ranges; the date simply didn't exist. The companies didn't want to go back and add those age ranges to their studies because that's very expensive. Thus, we have the current situation in which the implants are not approved for anyone younger than the age ranges in the available data, namely 22 years old, and this creates the perception in those who don't know the story that there is some medical reason for this. I have personally put in LOTS of silicone gel implants into ladies younger than 21, and I have never seen any increased risk or problems in those patients different from any others. I can do this, in fact any surgeon can, because of a thing called "off label use." Just like a doctor is legally, morally, and scientifically "allowed" to use any drug for something that it works for in his or her experience or in common practice, even though it might not be specifically approved by the FDA for that particular use. Until and unless the FDA goes back and approves that drug for that use, and use for that purpose is considered off label. An example of this might be aspirin. We mainly think of aspirin as a pain reliever for headaches and muscle aches; that was its original intented use. However, we also discovered that it helped thin the blood a little and prevent heart attacks and strokes, and lo and behold, every doctor started recommending that his patients take aspirin for heart attack prevention, not headaches. Now, aspirin never was a prescription drug, so it was never controlled by the FDA like a prescription drug, but this analogy is the clearest one to demonstrate what "off-label use" is. Thus, following that same logic, we can put silicone implants into ladies younger than 22, because it's considered "off-label." As long as you are at least 18 and of legal age and properly notified of this and consent is obtained, there is no reason why a surgeon can't, or shouldn't,, do this for you. There certainly is no liability created on their part because of it.The thing you have to know about off-label use, however, is that it might void the warranty for your implants. I have personally called each one of the 3 companies approved to sell implants in the US, Mentor, Sientra, and Allergan, and spoken directly to their representatives regarding this specific issue, and I have gotten varying answers. Mentor unequivocally will not honor their warranty for any off-label use of their silicone gel implants. This is not to say that you can't get Mentor implants put in before you're 22, just be aware that if you do and you have a rupture or some other issue normally covered under warranty, you might not be able to make a claim, and you would be on your own financially. Sientra on the other hand clearly assured me that their policy is to stand behind the judgment of the surgeon, and if the surgeon felt in his or her best medical judgment that a Sientra gel implant was best for the patient, they would honor any warranty claim on that patient regardless of her age, even if she were under 22 at the time of surgery. Allergan was not very clear at all, they waffeled and I got different answers from different people I spoke to. This is not to say that there isn't a policy for this in their company and SOMEONE in their company who doesn't know it, but I couldn't get it out of them, and I would say the safest way to proceed with them is to assume that they also would not honor the warranty for patients under 18. So there you have it. It boils down mainly to things like politics, financial matters, warranty coverage, and hassle factor for surgeons. None of it medical.I have gone to the trouble of telling you this maybe because I'm a dad of two grown daughters who, not necessarily interested in breast augmentation, but I think deserve to get good answers to their questions like this, especially when those answers don't make logical sense like this situation. I'm always a bit bothered when I see surgeons treat you young ladies dismissively and simply tell you "no, you can't have those implants until you're old enough." As I stated above, it would be one thing if it were that girls your age were just being bratty and wanting what they want, but as I argued above, there are real medical and social implications for this policy too, and the limited options you are being forced to accept. My best advice to you, if you really do want to get silicone gel implants before you turn 22, would be to just say "thank you and have a nice day" to any surgeon who dismisses you and tells you that "you can't have silicone implants until you are 22," and find a board certified plastic surgeon (not someone who is not properly trained and qualified to do breast augmentation surgery), preferably one who uses Sientra implants (based on what I discovered about the warranties), who approaches this issue much like I do, in that they use the implants off-label when indicated. There are lots of us out there, I know this, you just have to find the right one. Best of luck.
