Kelly Young, Physician's First Watch, Alain Joffe, MD, MPH, FAAP

These recommendations are also relevant for pediatricians whose adolescent patients have concerns about whether their development is normal.

The American College of Obstetricians and Gynecologists has published guidance for clinicians counseling adolescent patients seeking breast augmentation or reduction surgeries or labiaplasties.

The group recommends the following:

• Obstetricians and gynecologists should be prepared to offer nonsurgical alternatives for comfort and appearance (e.g., supportive garments, use of emollients, weight reduction).
• Clinicians should be prepared to discuss sexual development and the wide variation in breast and genitalia appearances.
• Clinicians should counsel patients before surgery or referral and assess their physical and emotional maturity.
• Adolescents requesting surgery should be screened for body dysmorphic disorder. Patients who screen positive should be referred to a mental health care provider.

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