Silicone in a Woman Under 22? (photo)

I'm 20. I have moderate breast asymmetry of one cup size difference (A vs. B cup). I want to correct this but saline feels unnatural to me and I don't want to end up feeling worse about my body. I consulted with a surgeon who said they would need a 100cc implant in the smaller one but it was impossible to order an implant in either saline/silicone of that size. Is this true? Also, can I get silicone because this is more corrective and not a basic augmentation? Do I need 2 implants for sure?

Doctor Answers 10

Of course you can have silicone implants!

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First of all, you should understand that you don't "need" to be judged "severely asymmetrical" in order to receive silicone gel implants.

Silicone implants under the age of 22 are perfectly legal and appropriate for patients who have fully informed consent, and understand that use of silicone implants under the age of 22 is considered "off-label" by the FDA.

Off-label use is something that every doctor does frequently, when a medication is prescribed for another reason than the primary FDA-approved indication. For example, Botox is approved for cosmetic use only for the frown muscles between the brows. I suspect that virtually every physician who uses Botox ALSO uses it for crows feet expression lines, forehead lines, and other areas as well. This is an example of "off-label" use. We're not breaking the rules, we are simply making an informed medical choice in conjunction with our properly-informed patient.

So , yes, it's possible; yes, it's legal; and I do this for my patients who are properly informed and choose that option.

Determining the difference in your breast volume is critical to choosing the best way to deal with your asymmetry. If you like the size of your larger breast, simply placing a 100cc implant in the other will do a very poor job of correcting the problem, since an implant this size has a very narrow base diameter (9.3cm for a 100cc Mentor moderate profile silicone gel implant, and 9.4cm for a Natrelle 120cc moderate profile implant) and will look very odd as it slides around in a pocket that is probably closer to 13 or 14cm wide. Furthermore, if you are truly a full cup different in breast volume, you may have a discrepancy larger than 100cc. Vectra 3D analysis is one way to more accurately determine the true volume discrepancy. Otherwise, all of us (some better than others) are simply "eyeballing" and guesstimating! Using that technique, I would estimate a 150-175cc discrepancy, not 100cc.

Another consideration is that although silicone gel implants have the softest and most natural "feel," an implant in one breast and nothing in the other will ALWAYS make your breasts feel different. If you are comfortable with larger breasts, using the smallest size appropriate for the anatomy of your larger breast would be my first decision, then finding the best match (larger silicone gel implant) for the smaller breast would be my best recommendation. Then, both breasts would feel similar, since both would have implants, and final total breast sizes would have the best symmetry. Perfect symmetry may not be possible, but this is the way to BEST achieve the closest match, IMHO.

You need to talk to a few other ABPS-certified plastic surgeons; especially those who support the right of properly-informed patients between the ages of 18 and 22 to consent and request the implants of their choice. I do. Best wishes! Dr. Tholen





Your options

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There are two great options to consider:
1. IDEAL implants - these are newly released "hybrid implants" double lumen saline implants made to feel like silicone
2. I will place silicone implants in patients under 22 yrs old but first have an informed consent and have them sign a waiver that they are aware that they are being used in "off label' FDA use.

Silicone in a Woman Under 22?

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In my opinion, there is no good reason why there is an FDA  mandated age of 22 for patients to receive silicone breast implants. There are many patients under the age of 22 who would ( based on their body type and the advantages of silicone breast implants) benefit from the use of silicone gel breast implants. Unfortunately, the use of these implants for these younger patients will negate the breast implant manufacturer warranty.

I hope this, and the attached link, helps.

Moderate asymmetry and the use of silicone under 22 years of age.

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Moderate asymmetry is a common condition in breast surgery. If you are happy with the current size of your right breast, then implant correction alone of the left may be considered reconstructive, although insurance clearance may be difficult. Silicone implants are not approved in cosmetic cases for women under the age of 22. However, if determined to be reconstructive in nature by your plastic surgeon then the use of silicone is acceptable. Other options include adjustable salines or fat grafting. 

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Silicone, saline, or fat

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Most plastic surgeons and patients would describe your asymmetry as moderate.  Your options are as you have stated to have the smaller one filled or to have both of them filled asymmetrically.  The "filling" options include saline implants, silicone implants, and fat grafting.  You like the size of your larger breast and would like to maintain that size you may want to entertain the idea of fat grafting to the smaller breast.  Just like silicone in patients younger than 22 there are not unanimous consensus about its use.  If you do not have a family history of breast cancer and would be willing to get a pre-operative breast imaging study just for a baseline, fat grafting to the smaller breast may be a viable solution for your asymmetry.

All the best,

Dr Remus Repta 

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

Options in breast augmentation foe assymetry

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You can have silicone implants fully understanding that the FDA approval is for 22 years and older and the fact that the warranty becomes void. Having said that, I think you are discounting saline implants. If you dont desire a large size and they are filled appropriately, they are the better choice for you. You can address assymetry better with saline implants as they are adjustable. Moreover, they can be placed though the belly button without any scars. Another option that you may be a candidate for Is fat transfer to the left breast. You would have to be examined to  get a full history and potential donor sites that would give you symmetry. This would be my first choice recommendation to you if you are happy with the size of your right breast. Best of luck. 

Silicone under age 22 is off-label use

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Hi there-

I completely agree with my colleague from Minneapolis.

While the FDA recommends that silicone only be used in women over age 22, there is nothing illegal or wrong about it being used in properly informed, appropriate candidates between ages 18 and 22 if after careful discussions this is their preference. It would simply be considered "off-label" use of the implant. 

Physicians use medications "off-label" all the time. The simplest example is Botox- which is truly only FDA approved for use on wrinkles between the eyes- but which is used daily by thousands and thousands of plastic surgeons and dermatologists for wrinkles in other locations, for excessive sweating, and even for headaches!

I do think that to get your very best outcome you will need to have an implant in both sides, but don't necessarily agree with your initial recommendation that you definitely need a 100cc implant. I personally believe that choosing the implant before surgery is a mistake...

My best recommendation for you is that you find the best, most talented surgeon you can- someone you like and feel you can trust, and then visit for a consultation. Remember that the goal is to keep you safe and for you to achieve the best appearance you can- find the best surgeon (not the best price, or the scar you like, or the implant you think you want) and your chances of achieving these goals will be higher.

Silicone under 22

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The FDA recommends the use of silicone implants in women over 22.  I adhere to that recommendation.  If you want to wait to have silicone that is fine.

Silicone in a Woman Under 22

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I would recommend an adjustable saline implant on your left side

This will allow you to accurately determine the correct size for symmetry

Your breasts  may also  grow further in the next year so you can adjust the volume

It is always possible to later convert to gel if you want,but at least you will know what the correct size is

Silicone breast implants under 22

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The FDA allows silicone gel filled implants for women under 22 to correct severe breast asymmetry...the definition of severe should be determined by your plastic surgeon and you...there are silicone gel implants of 125 cc...this is only 1/2  a shot glass  larger than 100 cc.

Leonard T. Yu, MD
Maui Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.