Can I get silicone implants if I'm 20?

Question

I really want to get silicone implants because they look and feel more natural, but I'm 20. Do some doctors allow patients under age get silicone implants ?

Ricardo A. Meade, MD · Answer

The FDA has only approved silicone breast implants for women who are 22 years old and older. However, if you give informed consent, you can likely find a board-certified plastic surgeon who will agree to use silicone for your breast augmentation. Using silicone in women younger than 22 is legal; it’s just considered an off-label use, much like prescribing a medication that the FDA approved as a beta-blocker to prevent migraines. Off-label use will likely void the warranty on your breast implants though. If you want the protection of a warranty, you may want to delay your breast augmentation until you are 22 or consider saline breast implants, which can also yield beautiful results.

Mark E. Mason, MD · Answer

This is "off label" under the age of 22 only because the FDA did not include women under the age of 22 in their extensive studies. It is legal and common for physicians to use medications and devices "off label." As previously mentioned by other doctors in this thread, Botox is so commonly used off-label, most patients don't realize it is used off-label. Botox is only "approved" for between the brows ("glabella") and "crow's feet," but is commonly injected in the forehead and other areas to relax wrinkles and/or muscles. Similarly, silicone implants are commonly implanted in women 18-21 years old, without adverse effects or reactions. It is legal, common, and appropriate, as long as the patient is informed, and consent is obtained.Hope this helps! Use a board certified plastic surgeon with experience!

Richard H. Tholen, MD, FACS · Answer

This is a very common question from time to time here on RealSelf. Please search "silicone implants under age 22 Tholen" for my answers, as well as the answers by others. Use of silicone gel implants under the age of 22 would be considered off-label, but this is both legal and common with many medications and devices. The important thing is that you understand the pros and cons of silicone vs. saline and consent and request their use.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 and crow's feet. I suspect that virtually 
every physician who uses Botox ALSO uses it for 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. I have never had one of my implant representatives fail to honor their replacement policy, so "warranty" is NOT void. Best wishes! Dr. Tholen

Shlomo Widder, MD · Answer

Dear Lizzy,   You live in a great country and you are free to choose  implants as you wish, however I would like to give you information about saline implants that will make you rethink about it and , hopefully, will change your decision. Saline implants have no age limitation.  I have been in plastic surgery practice for 29 years and performed breasts augmentation surgery on thousands of patients. I use almost exclusively smooth, round, moderate profile saline implants made by Mentor , for the following reasons:  1. Cost  $1000 less than silicone implants.  2. Statistically has less capsule contracture (breasts hardening) than silicone gel implants.  3. Allow for a short sub areola incision  entry, which is scar friendly. Large silicone implants require long sub mammary incision which is not scar friendly.  4. The sub areola incision, allows for the creation of consistently nice cleavage and precise fold, because it can be done under direct vision and feel, while the sub mammary incision is too far for comfort.  5. I have performed breasts augmentation surgery on many mothers and daughters and it is inconceivable that mothers would have referred me their daughters , if they were not happy with the outcome.   6. It is a myth that silicone implants are more natural than saline implants.  I have replaced many silicone implants with saline implants due to problems with the implants, to the delight of my patients. Moreover, quite a few of my patients had the breasts augmentation surgery before meeting their husbands and the husbands did not realize that their wives have implants...  7. In case of leakage or implant rapture (rare but happens), the saline implant replacement is very simple and can be done under local anesthesia, while silicone gel implant removal is more complex.      Finally, it is wiser to choose the right doctor over the 'right' implant or the 'right' tool. That is because not all results are the same, since experience, skills and aesthetic eye are critical for good outcome.   Always, consults with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and look natural. Also, check the 'realself' reviews for ratings and positive experience reports.                       Best of luck,                                              Dr Widder

Gregory T. Lynam, MD · Answer

It is off label but many things are done off label such as botox to other parts of the face other then the glabella which was only indicated area when it came on the market. In other counties no such discussion is needed. The FDA is the reason for this silly regulation. I recommend what is best for the patient! Good Luck!

Mathew A. Plant, MD, FRCSC · Answer

The FDA has only approved for use in 22year olds and over so it would be off label. You'd have to asked him surgeon on a case by case basis if they would do it for you. Best of lukc

Nelson Castillo, MD · Answer

Thank you for your excellent question.  Silicone implants can be placed in patients less than 22 years old but is considered an "off-label" use.  There is little physiologically different in a 20 year old woman compared to 22 and the age restriction is simply the result of the study evaluating the safety of silicone implants having women that were 22 years of age and older, not due to safety concerns.  Hope this helps.

Ram Kalus, MD, FACS · Answer

The short answer is "possibly". It depends on the judgment of your plastic surgeon, and a detailed conversation with you after evaluating you in person, along with a detailed informed consent. The FDA recommendation that saline filled implants be used for any woman under 22 years of age and conversely, that silicone gel implants should only be used in women over the age of 22, is exactly that, a recommendation. It is ultimately left to the discretion of the plastic surgeon and the patient, if it is felt by both, that the patient is a better candidate for having a silicone gel filled implant to be used in her surgery. Because of the published FDA guidelines, the use of a silicone gel implant in a woman under the age of 22 would be considered "Off label", and your plastic surgeon should discuss this with you so that you are fully informed about your options. As you begin to review your options, remember that the best way to
determine which breast implant size is best for you is by first finding out
your specific wishes not only with words or letters as in cup size or “not too
big” or “natural”, but also with a visual understanding of what you hope to
look like. This can be accomplished either with photographs of patients whose
breasts and body type look like you, or ideally with photos of patients not
only whose breasts and body type visually are similar to yours, but are also a
similar height, weight, and pre-operative breast size. In our own practice we
have provided that unique functionality on our website to accomplish exactly
that.

Unfortunately the most common reason for a woman to be
unhappy after her augmentation is feeling as though she is either too big or
not big enough. Thankfully, in our practice this is rarely a problem because
implant size selection is what we spend most of our time discussing and
determining. I do not place the onus of selecting the breast implant size on my
patients since they are coming to me for my advice and expertise, but I do ask
my patients to be as specific as possible about their aesthetic goals and I then
advise them accordingly.

I would advise you to seek the advice of a board certified
plastic surgeon experienced in breast enhancement surgery and make sure that
your own sense of aesthetics aligns with that of your plastic surgeon. Your
idea of “natural” or “pretty” or “proportionate” might be different from your
plastic surgeon’s and it is very important for you to feel confident that you
are both of like minds as far as the goals. Best of luck to you and I hope you
are successful in achieving the enhancement you are seeking.

Tom J. Pousti, MD · Answer

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; I therefore use these implants for any appropriate patient (regardless of age) routinely. I hope this, and the attached link, helps. Best wishes.

Brooke R. Seckel, MD, FACS (retired) · Answer

Using silicone breast implants for patients under 22 years old is considered off label. However many plastic surgeons are willing to do this. The main problem is that you may not be able to have the warranty. Discuss this with your surgeon.