Breast Reduction:


Indications — One or more of the following symptoms may lead the plastic surgeon to recommend breast reduction: 


?Chronic pain – The primary indication for breast reduction surgery is chronic pain in the breast, neck, shoulder, or midthoracic region of the back, oftentimes requiring pain medication for relief. Woman may also complain of headache, which is attributed to the constant neck and shoulder strain. Women who have underlying spine disease can have significant aggravation of their back pain. Pain, as an indication for surgery, has generally been present for several years and is intractable to standard treatments, such as physical therapy. A temporary improvement in pain immediately after a treatment may occur, but it often recurs once normal activities are resumed. Other failed treatments such as chiropractic treatments, massage therapy, and acupuncture also serve to support the medical indications for surgery.  


?Breast discomfort and physical impairment – Significant discomfort, which interferes with daily activities and leads to behavior modification to achieve some relief is another indication for breast reduction. Woman may complain of difficulty obtaining adequate support for their breasts during exercise, or discomfort in their breasts leading to a reduced level of physical activity. As a result, many women with macromastia find it difficult to lose weight.


?Chronic skin changes – Another indication for breast reduction surgery is skin changes, which include rash, hygiene problems, and skin infections in the intertriginous areas. The pendulous breast creates a large area of skin-on-skin contact in the region of the inframammary fold. Perspiration becomes trapped, particularly during hot weather, and fungal infections, skin maceration, and folliculitis are common problems (picture 3). Chronic inflammation weakens the skin’s tensile strength leading to fragile skin that can tear along the inframammary fold and in the intertriginous areas.   


?Neuropathy – Neuropathy of the upper extremities can also occur as a result of macromastia. The ulnar nerve is usually affected (compression of the anterior T1 rami) and manifests as numbness and paresthesias of the small and ring fingers [1].    


?Negative psychological effects – The negative psychological effects associated with macromastia are also compelling indications for surgery. Many women feel self-conscious about their appearance and do not want to draw attention to their large breasts. They have difficulties finding clothes that fit, they slouch, and they complain of poor posture. Some patients, especially younger women who seek this operation, have poor self-esteem and are reluctant to take part in activities in which they cannot easily hide their figure. 


Contraindications — High-risk surgical patients with substantial medical comorbidities (cardiopulmonary disease, morbid obesity) are not offered reduction mammoplasty, even if they meet the criteria listed above for breast reduction.