Adolescent Breast Reduction: Indications, Techniques, and Outcomes : Plastic and Reconstructive Surgery

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Adolescent Breast Reduction: Indications, Techniques, and Outcomes

Koltz, Peter F. M.D.; Myers, Rene P. M.D.; Shaw, Robert B. M.D.; Wasicek, Philip B.S.; Girotto, John A. M.D.

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Plastic and Reconstructive Surgery: June 2011 - Volume 127 - Issue 6 - p 158e-159e
doi: 10.1097/PRS.0b013e3182131ae4
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Sir:

With the rise in childhood obesity, an increase in the number of patients seeking adolescent breast reduction has been appreciated. The cause of macromastia in pubertal and parapubertal girls is variable and includes endocrine changes, childhood obesity, and juvenile (virginal) hypertrophy of the breast.1 Benefits of reduction mammaplasty include resolution of pain, improved quality of life, extroversion, and emotional stability. There is a paucity of literature regarding outcomes for a growing number of adolescent girls seeking breast reduction.2,3 We examined our experience with presenting symptoms, techniques, and both surgical and pathologic outcomes for reduction mammaplasty in the adolescent population.

Medical records of 76 consecutive patients younger than 18 years who underwent reduction mammaplasty over a 7-year period were identified and reviewed. Operative indications included neck, back, and/or shoulder pain (75 percent); intertrigo (8 percent); and shoulder grooving (17 percent). Difficulty finding bras (8 percent) and participating in sports (9 percent), and social distress (24 percent) were noted. Average body mass index was 31 kg/m2, and 65 percent of children were obese (body mass index > 30). Surgical correction most commonly included Wise pattern reduction with inferior pedicle (91 percent) and superior pedicle (8 percent). Complications occurred in eight patients (10.5 percent), including four partial wound dehiscences, three seromas, two cases of cellulitis, and one partial nipple loss. All of these patients were managed without return to the operating room. Pathologic examination yielded no cancers, with 80 percent normal or mildly fibrotic and 20 percent benign histology. Based on the cost determined by our pathologic review and incidence in the pediatric population (0.08 cases per 100,000), the resulting cost of one breast cancer diagnosis is $147 million.

Beyond the symptoms of macromastia shared by adult patients, there are special considerations in the young population requiring more attention. These include emotional status, future lactation success, nipple sensation, changes in breast morphology on subsequent pregnancy, and weight loss or gain. Reduction mammaplasty has been reported to greatly reduce or completely eliminate eating disorder symptoms and markedly improved body image.4 Although the majority of patients may demonstrate varying degrees of breast tissue regrowth, symptomatic relief and long-term patient satisfaction persist 6 years following surgical intervention; 94 percent of patients would undergo their procedure again.5 Whether these issues are present in our population following breast reduction remains to be determined, but our preliminary, short-term follow-up results are promising, with dissemination of these data to occur in the near future.

Adolescent macromastia can be a deforming, distressing, and disabling condition. Presenting symptoms, along with complication rates, of adolescent mammaplasty patients mirror those seen in the adult population. However, compared with their adult counterparts, the adolescent population displays greater obesity and presents with increased social distress and comorbid psychiatric disorders. Thus, surgeons should feel comfortable and obliged to perform reduction mammaplasty in the carefully selected adolescent patient in whom, with proper consent and expectations for complications, surgery may help alleviate the increased social, psychological, and physical strain caused by macromastia.

Peter F. Koltz, M.D.

Rene P. Myers, M.D.

Robert B. Shaw, M.D.

Philip Wasicek, B.S.

John A. Girotto, M.D.

University of Rochester Medical Center

Rochester, N.Y.

REFERENCES

1. Denzer C, Webel A, Muche R, Karges B, Sorgo W, Wabitsch M. Pubertal development in obese children and adolescents. Int J Obes. 2007;31:1509–1519.
2. Davis GM, Ringler SL, Short K, Sherrick D, Bengston BP. Reduction mammaplasty: Long-term efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg. 1995;96:1106–1610.
3. Glatt BS, Sarwer DB, O'Hara DE, Hamori C, Bucky LP, LaRossa D. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Plast Reconstr Surg. 1999;103:76–82; discussion 83–85.
4. Losee JE, Serletti M, Kreipe RE, Caldwell EH. Reduction mammaplasty in patients with bulimia nervosa. Ann Plast Surg. 1997;39:443–446.
5. McMahan JD, Wolfe JA, Cromer BA, Ruberg RL. Lasting success in teenage reduction mammaplasty. Ann Plast Surg. 1995;35:227–231.

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