A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research

Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.

Superomedial Reduction Mammoplasty Affects Patients’ Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients

Background Breast reduction using the superomedial technique can relieve symptoms related to breast hypertrophy; however, as the lateral and inferior portion of the breast parenchyma is removed and displaced, reduction mammoplasty may lead to an impaired ability to breastfeed. Objectives To assess the patient's ability to breastfeed after superomedial reduction mammoplasty. Methods This was a cross-sectional study including patients treated with superomedial reduction mammoplasty between January 2009 and December 2018 at two tertiary hospitals in Denmark. Patients were stratified into two cohorts, depending on whether they had childbirth before or after their reduction mammoplasty. Patients were sent specific questionnaires regarding maternity, breastfeeding before and after reduction mammoplasty, nipple sensitivity, and current demographic information. Operative details were retrieved from electronic medical records. Results We identified 303 patients eligible for this study (37 patients giving birth after and 266 before reduction mammoplasty). Fewer patients were able to breastfeed exclusively for the recommended six months after reduction mammoplasty (2/37 = 5.41%) compared to before (92/266 = 34.59%, p<0.05). Also, fewer patients were able to breastfeed at all after reduction mammoplasty (18/37 = 48.64%) compared to before mammoplasty (241/266 = 90.60%, p<0.001). Patients unable to breastfeed after reduction mammoplasty had less nipple sensitivity and more breast tissue excised (p<0.05). Conclusions Superomedial reduction mammoplasty seems to impair the patient's ability to breastfeed exclusively for the recommended 6 months. Patients of childbearing age considering reduction mammoplasty should be made aware that reduction mammoplasty reduces their breastfeeding capacity.

Skin-Reducing Mastectomy and Immediate Reconstruction for a Large Recurrent Borderline Phyllodes Tumor

Background: Large recurrent phyllodes breast tumors are often malignant. Therefore, when taking the surgical decision, a simple mastectomy and immediate reconstruction must be considered. Case presentation: The patient, aged 40 years, with a benign phyllodes tumor in the left breast, having a recurrence 2 years after, with 4–7 cm conglomerate tumor masses, was subjected to skin-reducing mastectomy, breast reconstruction with a silicone mammary implant in the left breast, and symmetrization of the right breast. Discussion and conclusions: In the case of patients with breast hypertrophy and gigantomastia (cup size D–F), skin-reducing mastectomy and immediate reconstruction with an implant can be the option. It is important for the resection specimen to include the skin tissue above the tumor. After 14 months of follow-up, there was no recurrence of the lesions on a clinical examination, ultrasonography, or MRI.

Bilateral Breast Abscess in a Newborn Baby

Background: In this study we wish to attract attention to mistaken interventions to the breast tissue of neonates and to increase awareness about this topic among personnel providing health services to neonates. Case presentation: A fourteen-day male infant was brought to the pediatric emergency clinic with swelling, redness, hardness and discharge complaints in the region of both breasts. Ultrasonography of the breast tissue of the patient identified appearance compatible with a dense-content abscess in the form of hyperechoic or hypoechoic avascular mass. Bilateral breast abscess responded to surgical and medical treatment. Conclusions: It is important to recognize physiological breast hypertrophy in newborns. In physiological hypertrophy, the breast bud is neither red nor soft and heals spontaneously. No intervention is required.