Reduction Mammoplasty

2019 ◽  
pp. 649-664
Author(s):  
M. Mark Mofid ◽  
Gehaan D’Souza ◽  
Benjamin E. Cohen ◽  
Michael E. Ciaravino
Keyword(s):  
Patient Satisfaction ◽  
Breast Reduction ◽  
Reduction Mammaplasty ◽  
Well Being ◽  
The United States ◽  
Reduction Mammoplasty ◽  
Strongly Correlated ◽  
Breast Reduction Surgery ◽  
Developmental Factors ◽  
Wise Pattern

Breast reduction is one of the more common plastic surgery operations performed in the United States. There were 1,00,000 operations performed in 2015. The etiology of breast hypertrophy is unclear and likely involves some combination of hormonal, genetic, and developmental factors. Patients with mammary hypertrophy complain of intertriginous infections, back and shoulder pain, shoulder notching, physical inactivity, dissatisfaction with breast appearance, poor sexual well-being, and poor psychological well-being. The goals of breast reduction surgery are to reduce overall breast volume, maintain nipple-areola viability, and achieve a shape that is aesthetically pleasing. Breast reduction improves patient satisfaction with breast appearance as well as physical and psychosocial well-being. Overall patient satisfaction is most strongly correlated with happiness with the appearance of the breasts. A number of techniques have been developed that effectively meet these goals. Three techniques are described in this chapter: inferior pedicle Wise pattern reduction mammaplasty, vertical pattern breast reduction, and partial breast amputation with free nipple-areola grafting.

Reductio Ad Absurdum: Examining the Validity of the 500-gram Rule in Reduction Mammaplasty

2020 ◽  
Author(s):  
Minji Kim ◽  
Mahmood J Al Bayati ◽  
Prakash J Mathew ◽  
Seth R Thaller
Keyword(s):  
Patient Satisfaction ◽  
Reduction Mammaplasty ◽  
Symptomatic Relief ◽  
Reduction Mammoplasty ◽  
Insurance Companies ◽  
Cochrane Central Register ◽  
Common Procedure ◽  
Form And Function ◽  
Hard Evidence ◽  
And Function

Abstract Background Reduction mammoplasty is a common procedure associated with a very high patient satisfaction rate. It has been shown to alleviate symptoms related to macromastia, such as back, neck, and shoulder pain, poor posture, bra strap grooving, paresthesia, and rashes. Despite the manifold benefits of reduction mammaplasty, some insurance companies require minimum resection weights of at least 500-grams per breast in order to distinguish between a reconstructive and aesthetic procedure. Objective The aim of this study is to assess the origins of the 500-gram rule used in reduction mammaplasty. Methods A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through July 2020 with multiple search terms related to resection weight criteria for breast reduction. Data on criteria, outcomes, and patient satisfaction were collected. Results A total of 14 articles were selected from the 27 articles that were identified. 500-gram rule appears to be arbitrary. It appears that it is not based on any available hard evidence. However, numerous studies show that patients who have less than 500-grams of tissue removed from each breast still experience significant symptomatic relief from reduction mammaplasty with a marked improvement in quality of life. Conclusion The 500-gram rule should be re-evaluated as criterion for pre-authorization reduction mammaplasty for insurance companies. It may influence surgeons to choose between form and function. Many additional patients might then benefit from this procedure with significant benefits.

Frequency of Headaches in Macromastia Patients and Relief After Reduction Mammoplasty

2021 ◽  
Author(s):  
Bilgen Can
Keyword(s):  
Breast Tissue ◽  
Breast Reduction ◽  
Reduction Mammoplasty ◽  
Chi Square ◽  
Level Of Evidence ◽  
Breast Reduction Surgery ◽  
Tissue Removal ◽  
Headache Relief ◽  
Kolmogorov Smirnov ◽  
Relief Rate

Abstract Background Several studies have reported that neck, back, and shoulder pain can be reduced after macromastia. However, only 1 study has specifically investigated the relation between macromastia and headaches. Objectives This study aimed to determine the frequency of headaches in patients with macromastia by examining a sample from our clinic and to determine whether the patients experienced headache relief following breast reduction surgery. Methods One hundred patients, out of 456 patients who met the criteria, were contacted by telephone and administered a questionnaire. Statistical analysis was performed with SPSS version 17.0. Normal distribution of the variables was examined by histograms and Kolmogorov-Smirnov tests. Pearson’s chi-square and Fisher’s exact tests were used to compare groups. The Mann-Whitney U test was used to evaluate nonparametric variables between the patients who has 1500 grams or less breast tissue removed and the patients more than 1500 grams breast tissue removed. Results The incidence of headaches in patients with macromastia was found to be 29%. Among the patients with headaches, 65.52% reported relief after surgery. The relief rate for headaches was found to be associated with the amount of tissue removed. Conclusions The incidence of headaches increased in patients with macromastia compared with the general population, and patients reported headache relief after surgery. In addition, as the amount of tissue removal increased, the relief rate for headaches after surgery also increased. Although additional studies are essential, preoperative headaches should be evaluated in breast reduction patients, and the removal of larger amounts of breast tissue should be considered among patients who report headaches. Level of Evidence: 4

scholarly journals Recommendations for Pathologic Evaluation of Reduction Mammoplasty Specimens: A Prospective Study With Systematic Tissue Sampling

2017 ◽  
Vol 141 (11) ◽  
pp. 1523-1528 ◽  
Author(s):  
Abiy B. Ambaye ◽  
Andrew J. Goodwin ◽  
Susan E. MacLennan ◽  
Shelly Naud ◽  
Donald L. Weaver
Keyword(s):  
Reduction Mammaplasty ◽  
Previous History ◽  
The United States ◽  
Reduction Mammoplasty ◽  
Atypical Hyperplasia ◽  
Pathologic Evaluation ◽  
Microscopic Evaluation ◽  
Pathologic Findings ◽  
History Of ◽  
A Prospective Study

Context.— Breast reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed in more than 100 000 patients per year in the United States. The reported incidence of significant pathologic findings (SPF), that is, carcinoma and atypical hyperplasia, ranges from 0.06% to 12.8%. No standard pathology assessment for RMP exists. Objectives.— To propose standard sampling for microscopic evaluation in RMP specimens, to evaluate the incidence of occult carcinoma and atypical hyperplasia, and to identify clinical risk factors for SPF in patients undergoing RMP. Design.— All RMP specimens from 2006 to 2013 at a single institution were prospectively examined. After baseline gross and microscopic evaluations, each specimen was subjected to systematic additional sampling. The incidence of SPF was tabulated, and variables such as age, specimen weight, previous history of SPF, and results of preoperative mammogram were examined. Clinical follow-up review was also subsequently undertaken. Results.— A total of 595 patients were evaluated. Significant pathologic findings were present in 9.8% (58 of 595) of patients. No cancer was identified in patients younger than 40 years; the rates of carcinoma were 2.4% (14 of 595) in all patients, 3.6% (14 of 392) in patients aged 40 years or older, and 4.3% (10 of 233) in patients aged 50 years or older. No carcinoma or atypical hyperplasia was identified on preoperative mammogram. Increased sampling was associated with a significantly greater frequency of SPF only in patients aged 40 years or older. Conclusions.— In patients younger than 35 years, gross-only evaluation is sufficient. However, increased sampling may be necessary in patients older than 40 years.

scholarly journals Giant Breast Hypertrophy in Juvenile: A Rare Case

2020 ◽  
Vol 14 (2) ◽  
pp. 60
Author(s):  
Dila Junita ◽  
Edmond Rukmana Wikanta
Keyword(s):  
Breast Reduction ◽  
Early Stage ◽  
Psychosocial Problems ◽  
Reduction Mammoplasty ◽  
Treatment Modalities ◽  
Breast Hypertrophy ◽  
Breast Reduction Surgery ◽  
Benign Condition ◽  
Breast Enlargement ◽  
Severe Back Pain

Introduction: Juvenile hypertrophy of the breast (JHB) is a benign condition that can lead to gigantomastia in adolescence. The development of breast enlargement in adolescence can cause both physical and psychosocial problems. Therefore, appropriate investigation and proper management at an early stage of the disease are very important. One of the treatment modalities is breast reduction surgery which ideal and offers an improvement in the quality of life. Case Presentation: A 13-year-old female with massive bilateral breast enlargement for a period of 8 months. The patient also complained of severe back pain and neck discomfort since her breast progressively enlarged. Psychosocial problems were recorded. Right breast reduction was performed and closed with inverted-T mammoplasty. The post-operative period was uneventful, and the patient was discharged on day 5 after the operation. Conclusions: Reduction mammoplasty is well accepted by adolescents with juvenile breast hypertrophy and can improve physical and psychological outcomes.

scholarly journals The Hybrid Breast Reduction; Taking Advantages of from Both the Vertical and Wise Pattern Reductions

2016 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Breast Reduction ◽  
Reduction Mammaplasty ◽  
Skin Incision ◽  
Hybrid Technique ◽  
Vertical Scar ◽  
Aesthetic Result ◽  
Advantages And Disadvantages ◽  
Type Pattern ◽  
Wise Pattern ◽  
Breast Projection

Reduction mammaplasty is one of the most commonly performed procedures by plastic surgeons. The Wise and vertical scar techniques are two of the most commonly published and performed techniques. The superior technique has long been argued. The advantages and disadvantages of each are well documented. We show a technique which combines the best aspects of the Wise and vertical pattern reductions. In this “Hybrid” technique, we use a typical superior medical pedicle that would be typically used in a vertical pattern and use a skin incision and tissue resection pattern of that of a Wise type pattern. By doing using this technique , the surgeon is able to utilize advantages of the two well-known reduction types. The hybrid reduction uses a robust and reliable superior type pedicle which also allows for a quick de epithelization and dissection of the pedicle. By using the Wise type (anchor shaped skin incision) a large amount of tissue is able to be harvested and the breast projection is restored and is aesthetically favorable. This paper outlines several important points which can aid in achieving an optimal aesthetic result when performing the hybrid breast reduction.

scholarly journals The expanded inframammary fold triangle: Improved results in large volume breast reductions

2014 ◽  
Vol 47 (01) ◽  
pp. 65-69 ◽  
Author(s):  
Karan Chopra ◽  
Kashyap Komarraju Tadisina ◽  
Alexandra Conde-Green ◽  
Devinder P Singh
Keyword(s):  
High Risk ◽  
Large Volume ◽  
Breast Reduction ◽  
Reduction Mammaplasty ◽  
Inframammary Fold ◽  
Wound Complications ◽  
Obese Patients ◽  
Inferior Pedicle ◽  
Improved Outcomes ◽  
Wise Pattern

ABSTRACT Context: The inferior pedicle, Wise-pattern reduction mammaplasty is the most popular technique for breast reduction because of its reproducible results and reliability. However, complication rates in super obese patients or patients receiving large volume reductions are high, ranging from 35 to 78%. These complications include delayed healing, infection, seroma, nipple-areolar complex necrosis, fat necrosis and development of hypertrophic scars. Aims: This study aimed to determine whether a modification to the standard Wise-pattern reduction technique, an expanded inframammary fold skin triangle, produces improved outcomes in high-risk large volume breast reduction patients. We report that this modification leads to improved outcomes by decreasing wound complications and improving aesthetic appearance. Settings and Design: Twenty-two patients received the inferior pedicle Wise-pattern reduction mammaplasty, which was modified to include an 8 cm wide inferior pedicle. This pedicle was de-epithelialized and an 8 Χ 3 cm 2 triangle of skin was preserved at the inferior base to reduce tension at the triple point, inverted T-closure. Materials and Methods: A retrospective review was performed on all patients who underwent reduction mammaplasty with the expanded inframammary fold (eIMF) technique as well as all patients who received the standard wise pattern technique. Statistical Analysis Used: A student t-test was performed for both reduction populations using SPSS software package. Statistical significance was defined as P < 0.05. Results: The average patient age was 32.25 years old (range 18-59), average BMI was 35.0, and average tissue mass removed per breast was 1378.39 g. The modified technique was found to produce a statistically significant (P < 0.05) increase in the amount of breast tissue removed (693.96 g increase in the left and 571.21 g in the right) as well as a statistically significant (P < 0.05) reduction in dehiscence (75% reduction) and post-operative infection (44.10%). Conclusions: This method is an easily reproducible and reliable technique that produces a favourable cosmetic outcome with acceptable, sustainable results in high-risk reductions in obese patients.

Assessing Disparities in Reduction Mammaplasty: There Is Room for Improvement

2021 ◽  
Author(s):  
Martin P Morris ◽  
Adrienne N Christopher ◽  
Viren Patel ◽  
Robyn B Broach ◽  
John P Fischer ◽  
...  
Keyword(s):  
Breast Reduction ◽  
Reduction Mammaplasty ◽  
Group Analysis ◽  
Surgical Care ◽  
Well Being ◽  
Median Income ◽  
Level Of Evidence ◽  
Black African ◽  
Patient Reported

Abstract Background Racial and socioeconomic disparities in access and quality of surgical care are well documented in many surgical subspecialties, including plastic surgery. Objectives The authors aimed to determine if demographic disparities exist in preoperative and postoperative satisfaction after breast reduction mammaplasty, utilizing patient-reported quality of life (QoL) scores. Methods Patients who underwent breast reduction mammaplasty between 2015 and 2020 were identified. Patients who underwent complex concomitant procedures were excluded. Patient demographics and QoL, as measured by the BREAST-Q, were extracted. Wilcoxon Rank Sum and Kruskal-Wallis tests were employed to compare QoL scores across demographic subgroups. Results A total of 115 patients met the inclusion criteria. QoL improved across all 4 BREAST-Q domains (all P &lt; 0.001). Disparities were shown to exist in the following: median income vs postoperative satisfaction with information (P &lt; 0.001), BMI vs preoperative physical well-being (P &lt; 0.001), and ethnicity vs preoperative physical well-being (P = 0.003). A sub-group analysis of Caucasian patients compared with Black/African American patients revealed significant inequalities in BMI (P &lt; 0.001), median income by zip code (P &lt; 0.001), improvement in satisfaction with breasts (P = 0.039), satisfaction with information (P = 0.007), and satisfaction with office staff (P = 0.044). Conclusions Racial and socioeconomic inequalities exist in preoperative and postoperative satisfaction for patients undergoing breast reduction mammaplasty. Institutions should focus on developing tools for equitable and inclusive patient education and perioperative counseling. Level of Evidence: 2

Age and Body Mass Index Affect Patient Satisfaction Following Reduction Mammoplasty: A Multicenter Study Using BREAST-Q

2021 ◽  
Author(s):  
Mads Gustaf Jørgensen ◽  
Elin Albertsdottir ◽  
Farima Dalaei ◽  
Jørgen Hesselfeldt-Nielsen ◽  
Volker-Jürgen Schmidt ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Well Being ◽  
Reduction Mammoplasty ◽  
Inferior Pedicle ◽  
Related Factors ◽  
Patient’S Satisfaction ◽  
Time Of Surgery ◽  
Postoperative Scar ◽  
Inferior Pedicle Technique

Abstract Background Reduction mammoplasty effectively improves quality of life for women with macromastia. However, little is known whether surgical- or patient-related factors affect satisfaction. Objective To investigate factors associated with altered patient satisfaction following reduction mammoplasty. Methods A cross-section study was performed by sending the BREAST-Q Reduction module to all patients, whom had undergone reduction mammoplasty between January 2009 and December 2018 at two tertiary Danish hospitals. Demographics, pre-, per- and postoperative details were gathered from electronic medical records. Results 393 patients returned the questionnaire and were eligible for the study. Increasing age at the time of surgery was associated with higher satisfaction with breasts (p&lt;0.001), nipples(p&lt;0.001), headache(p &lt;0.05), psychosocial well-being(p&lt;0.001), and outcome(p&lt;0.05). Increased BMI at the time of surgery negatively affected satisfaction with breasts(p&lt;0.05) and psychosocial well-being(p&lt;0.05). Increase in BMI after surgery was further associated with lower satisfaction with breasts(p&lt;0.05), nipples(p&lt;0.05), sexual well-being(p&lt;0.05), and more pain in the breast area(p&lt;0.05). Postoperative scar revision and wound infection was more common following inferior pedicle technique than superomedial technique(p&lt;0.05) and negatively affected satisfaction with outcome(p&lt;0.05) and pain in the breast area(p&lt;0.05). Conclusion Patients should be motivated to optimize their weight prior to reduction mammoplasty to achieve optimal satisfaction. Furthermore, reduction mammoplasty can benefit obese patients by facilitating subsequent weight loss for additional satisfaction. Age was associated with improved patient satisfaction and this should considered when operating on younger patients. Postoperative complications affect patient’s satisfaction and the superomedial technique seems to be a better choice than the inferior pedicle technique in medium-large breasts.

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