[Breast reduction surgery as an example of surgery on demand in adolescents]

Surgical options to optimise one's body image are also accessible to adolescents. Although the vast majority of surgical procedures in this group of patients focus on otoplasty, 4 % of procedures in Germany are performed on the breast. The onset of menarche has not changed much in recent years, but obesity seems to generate problems with the breast for young girls. Since it is difficult to assess maturity and psychological resilience in young patients, a plastic surgeon is faced with an area of conflicts regarding his or her will to meet patients' reasonable wishes to ease their suffering, offer reliable and sustainable results, and comply with legal regulations that are largely uncertain. This article tries to explain the relevant jurisdiction and legislation with a view to the special legal situation regarding adolescents, and recommends options to bridge prevalent uncertainties. The goal in decision-making in this group of patients will be to thoroughly assess the adolescent's ability to appreciate pros and cons, and to include third parties who will eventually influence the adolescent's decision and judgement of a result also in the future.