Abstract
Background
Italian law no. 86 of 5 June 2012, which establishes a set of rules on the matter of breast implants, came into effect in July 2012. The law is at the center of a widespread and animated cultural debate that in recent years has been taking place in Italy.
Discussion
The fundamental prohibition imposed by the law concerns the age limit. Breast implants for exclusively aesthetic purposes are allowed only if the legal age (18 years) has been reached. This prohibition does not apply in cases of severe congenital malformations certified by a physician operating within the National Health Service or by a public health care institution. The legal imposition of an age limit raises a number of perplexities: one at a bioethical level and one that is strictly juridical. In fact, it is impossible to deal with this issue unless the wider debate concerning the self-determination and autonomy of underage patients in biomedical matters is considered. It appears, then, that the issue is again exclusively related to the peculiarity of cosmetic surgery, which when aimed at correcting “only” the pathologic experiences of self-image, does not acquire the dignity of therapy. If, however, the improvement of self-image serves to achieve a better psycho-emotional balance and favors the development of social relations undermined by evident physical defects, age restrictions can be disregarded.
Summary
The authors believe the real risk is that the law imposed by the Italian state is based on assumptions and preformed value judgments. Furthermore, in the understanding of needs, legislation often is biased toward objective biophysical problems without attaching due importance to subjective psychological and social problems. While acknowledging the seriousness of the issue, the authors do not agree with the legislature’s rigidity. However, plastic surgeons must form a plan for addressing the concerns about breast implants and evaluating whether they are appropriate for adolescents, taking into account the unique psychological and developmental considerations of adolescent cosmetic surgery patients.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
American Society of Plastic Surgeons: Policy Statement: Breast Augmentation in Teenagers. Retrieved xxxx at http://www.plasticsurgery.org/medical_professionals/health_policy/loader.cfm?url_/commonspot/security/getfile.cfm&PageID_21757, 2004
Atiyeh BS, Rubeiz MT, Hayek SN (2008) Aesthetic/cosmetic surgery and ethical challenges. Aesthetic Plast Surg 32:829–839
Botti G, Cella A (2002) Breast augmentation as an incentive in recovering from anorexia. Aesthetic Plast Surg 26:44–49
Chung KC, Pushman AG, Bellfi LT (2009) A systematic review of ethical principles in the plastic surgery literature. Plast Reconstr Surg 124:1711–1718
De Roubaix JA (2011) Beneficence, nonmaleficence, distributive justice, and respect for patient autonomy: reconcilable ends in aesthetic surgery? J Plast Reconstr Aesthet Surg 64:11–16
Fineschi V, Neri M, Turillazzi E (2005) The new Italian law on assisted reproduction technology (Law 40/2004). J Med Ethics 31:536–539
Gasques JAL, Pereira de Godoy JM, Navarro Cruz EMT (2008) Psychosocial effects of otoplasty in children with prominent ears. Aesthetic Plast Surg 32:910–914
Italian National Committee of Bioethics, Information and Consent to Medical Treatment, Presidency of the Council of Ministers, Rome, Italy, published 20 June 1992
Italian National Committee of Bioethics, Bioethics with Childhood, Presidency of the Council of Ministers, Rome, Italy, published 22 January 1994
Italian National Committee of Bioethics, Bioethical Aspects of Aesthetic and Reconstructive Surgery, Presidency of the Council of Ministers, Rome, Italy, published 5 July 2012
Italian Society of Plastic, Reconstructive, and Aesthetic Surgery. Retrieved xxxx at http://www.sicpre.it/
Khunger N (2013) Guest editorial: challenging issues in aesthetic surgery. Indian J Dermatol Venereol Leprol 79:30–31
Larson K, Gosain AK (2012) Cosmetic surgery in the adolescent patient. Plast Reconstr Surg 129:135e–141e
Marchesi A, Marchesi M, Fasulo FC, Morini O, Vaienti L (2012) Mammoplasties and medicolegal issues: 50 Cases of litigation in aesthetic surgery of the breast. Aesthetic Plast Surg 36:122–127
McGrath MH, Schooler WG (2004) Elective plastic surgical procedures in adolescence. Adolesc Med Clin 15:487–502
Mendelson BC (2008) Aesthetic/cosmetic surgery and ethical challenges. Aesthetic Plast Surg 32:840–841
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. Retrieved xxxx at http://www.who.int/
Sterodimas A, Radwanski HN, Pitanguy I (2011) Ethical issues in plastic and reconstructive surgery. Aesthetic Plast Surg 35:262–267
Trussler AP, Tabbal GN (2012) Patient safety in plastic surgery. Plast Reconstr Surg 130:470e–478e
Turillazzi E, Fineschi V (2011) Advance directives in therapeutic intervention: a review of the Italian bioethical and juridical debate. Med Sci Law 51:76–80
Watson R (2003) EU parliament calls for tougher rules on breast implants. BMJ 22:414
Zuckerman DM, Abraham A (2008) Teenagers and cosmetic surgery: focus on breast augmentation and liposuction. J Adolesc Health 43:318–324
Zuckerman DM (2010) Reasonably safe? Breast implants and informed consent. Reprod Health Matters 18:94–102
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Turillazzi, E., Neri, M., Riezzo, I. et al. Informed Consent in Italy—Traditional Versus the Law: A Gordian Knot. Aesth Plast Surg 38, 759–764 (2014). https://doi.org/10.1007/s00266-014-0337-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-014-0337-z