Reduction Mammaplasty for Macromastia in Adolescents

A Systematic Review and Pooled Analysis

Alexandra S. Hudson, M.D., H.B.Sc.; Alexander D. Morzycki, M.D., M.Sc.; Regan Guilfoyle, F.R.C.S.C.

Disclosures

Plast Reconstr Surg. 2021;148(1):31-43. 

In This Article

Abstract and Introduction

Abstract

Background: Reduction mammaplasty for macromastia is one of the most common operations performed by plastic surgeons. There remains hesitancy in operating on adolescents, as there is ongoing debate about breast regrowth and potential impact on breastfeeding. The goal of this study was to analyze these concerns by reviewing the current literature.

Methods: A systematic review of MEDLINE, Scopus, and Google Scholar was conducted using the following terms: "breast reduction" or "mammaplasty" or "breast reconstruction" and "adolescent" or "youth" or "pediatric" or "child" or "teen." Primary outcomes were success of breastfeeding after the procedure and procedure-related complications.

Results: Twenty-three studies (87 percent retrospective), consisting of 2926 patients with preoperative cup sizes of C to KK (mean, DDD), met inclusion criteria. Mean age at the time of surgery ranged from 16 to 21 years, with the youngest patient being 12 years old. The overall complication rate was 27.3 percent (95 percent CI, 14.4 to 42.5 percent). Minor complications (22.8 percent; 95 percent CI, 10.2 to 38.5 percent) were more common than major (4.2 percent; 95 percent CI, 1.6 to 7.9 percent). Eighteen percent of patients (95 percent CI, 2.2 to 43.8 percent) reported regrowth of their breast tissue postoperatively, with 2.7 percent (95 percent CI, 0.9 to 5.5 percent) undergoing a second revision mammaplasty. Fifty-three percent of patients (95 percent CI, 36.0 to 69.3 percent) did not attempt breastfeeding. Of those who attempted, 55.1 percent (95 percent CI, 34.4 to 74.9 percent) were successful.

Conclusions: Prospective data are lacking. Patient counseling should focus on encouraging a trial of breastfeeding, despite surgical history. One-fifth of adolescent patients may notice breast regrowth postoperatively; however, the amount of regrowth is likely small and unlikely to reexacerbate symptoms, as the rate of revision surgery is small.

Introduction

Macromastia, or benign breast hypertrophy, often leads to symptoms that can be debilitating for individuals. These include pain, intertriginous dermatitis, restrictive respiratory effort, self-esteem issues, limitations on activity participation, and others.[1] Preoperatively, patients with macromastia have been shown to have a significantly worse health-related quality of life compared to the normal population.[1] Bilateral reduction mammaplasty is a very common plastic surgery procedure undergone for macromastia.[2,3] It is known to reduce symptoms and improve quality of life, and can often be done as an outpatient procedure.[4,5] In 2018, it was the eighth most common procedure performed by plastic surgeons around the world. The number of these operations performed is also increasing over time, with an increase in 8.5 percent worldwide from 2017 to 2018, and by almost 20 percent from 2014 to 2018.[3]

There is ongoing hesitancy when it comes to offering this surgery to adolescent patients, as there are concerns about the risk of significant breast regrowth requiring repeated revision surgery in the future, as breast development is often not complete until age 18 years. There are also concerns about the potential negative impact of surgery on nipple sensation and future breastfeeding, as the majority of adolescent patients will not yet have had children. The primary aim of this review was to summarize the literature to date on the success of breastfeeding after reduction and develop a comprehensive safety profile for this procedure in adolescent patients.

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