Top Surgery Restricted for Minors but Cosmetic Breast Surgery Isn’t

The American Society of Plastic Surgeons (ASPS) performed 7,899 cosmetic breast augmentations and reductions on teens between the age of 13 and 19 in 2020. The New York Times reported that 203 known top surgeries—a procedure sought by transgender individuals to remove breast tissue—were performed on minors in 2021. Despite fewer top surgeries and similarities between the procedures, recent legislation has targeted gender-affirming care, individuals below 18 seeking that care, and their parents.

A brief from The School of Law Williams Institue at the University of California Los Angeles reports that as of March 2022, 15 states are either considering or have passed laws that restrict gender-affirming care. One such law was passed by the Arizona House of Representatives in March; it will begin prohibiting physicians from “performing irreversible gender reassignment surgeries on minors” in 2023. Data collected by the Williams Institute displays that more than a third of transgender youth between the ages of 13 and 17 live in one of the 15 states. They estimate that 58,200 transgender youth and young adults are at risk of losing access to care.

Proponents of gender-affirming surgery often claim that minors may regret their decisions and de-transition later, but according to Advocate only 2.5% of transgender youth de-transition after five years. Also, adversaries have not raised the same level of concern for teens undergoing cosmetic breast surgery. For these procedures—which are not dissimilar from top surgeries—the ASPS requires parental consent and recommends in a 2015 brief that parents should “evaluate the teenager’s physical and emotional maturity and believes that individual cases merit careful evaluation under the guidance of a plastic surgeon certified by The American Board of Platic Surgery.” This parallels with recommendations for trans youth from other professional associations such as the United States Professional Association for Transgender Health (USPATH).

The recommendation is also similar to that of the Children’s Hospital Los Angeles which recommends in their study, Experience of Chest Dysphoria and Masculinizing Chest Surgery in Transmasculine Youth, that “professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.” They surveyed 136 transgender individuals between 13 and 25; half of them had gender-affirming top surgery, and only one individual reported regretting the procedure. Furthermore, the study found that those who did not undergo surgery reported significantly more distress.

Overall there is a lack of data in the field of gender-affirming surgery and its effect on trans youth; however, the majority of data has trended toward individual benefits rather than harm. Without enough quantitative support to dictate legislation, decisions concerning trans youth similarly to decisions concerning any teenager seeking a medical procedure should only be discussed between physicians, the child, and their guardian as recommended by numerous institutions such as the ASPS and USPATH.

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