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mastectomy after mastopexy or reduction. Complications occurred in four (17%) of the 24 breasts
including skin flap necrosis (n=2 breasts), minimal partial nipple-areola complex necrosis (n=3
breasts) and an expander explanted for infection related to skin flap necrosis (n=1 breast).
Successful nipple-sparing mastectomy and prior mastopexy or reduction (without residual effects
of the nipple-areola complex or skin flap necrosis) occurred in 14 patients (23 breasts, 96%).
Nipple inversion or retraction is when the nipple is pulled in and points inward instead of out. It
can affect one breast or both and can be acquired or congenital. The cause of acquired nipple
inversion can be due to benign or malignant causes. Congenital nipple inversion is usually bilateral
and is benign (Killelea and Sowden, 2022). Correction of nipple inversion is considered cosmetic in
nature and not medically indicated.
Literature Review
Controlled clinical studies assessing the effectiveness of surgical removal of modest amounts of
breast tissue in reducing neck, shoulder, and back pain and related disabilities in women are
lacking. Despite the lack of controlled studies, reduction mammoplasty has become the standard
of care for a subset of individuals with symptomatic macromastia. Evidence suggests that
calculating breast reduction in correlation to each patient’s body weight and height can have an
effect on reducing preoperative signs and persistent physical conditions. (Cunningham, et al.,
2005; Blomqvist, et al., 2004; Souto, et al., 2003; Collins, et al., 2002; Ayhan, et al., 2002;
Bruhlmann, et al., 1998).
Chadbourne et al. (2001) conducted a systematic review and meta-analysis of 29 studies of 4173
patients to determine whether reduction mammoplasty improves measurable outcomes in women
with breast hypertrophy. Experimental and observational studies were included; no randomized
controlled trials were found. Outcomes assessed were postoperative physical signs and symptoms
such as shoulder pain, shoulder (bra strap) grooving, and quality-of-life domains, such as physical
and psychological functioning, and were expressed primarily as risk differences. The mean body
mass index of the patients was 27.5 kg/m
2
in the observational studies and 29.6 kg/m
2
in the
experimental studies. The average tissue mass removed per breast was approximately 1400
grams. The authors concluded that reduction mammoplasty was associated with a statistically
significant improvement in physical signs and symptoms involving shoulder pain, shoulder
grooving, upper/lower back pain, neck pain, intertrigo, breast pain, headache, and pain/numbness
in the hands. The quality-of-life parameter of physical functioning was also statistically significant,
while psychological functioning was not significant. The evidence suggests that women undergoing
reduction mammoplasty for breast hypertrophy have significant postoperative improvement in
preoperative signs and symptoms, quality of life, or both.
Breast Reduction by Liposuction
Suction lipectomy or ultrasonically-assisted suction lipectomy (liposuction) as a sole procedure has
been introduced as an alternative method in reducing breast size. The effectiveness of liposuction,
in terms of removing glandular breast tissue, rather than fatty tissue in the breast, remains to be
demonstrated. Evidence supporting the effects of this approach on patient outcomes has been
limited to retrospective/prospective uncontrolled studies and case series, and there are minimal
long-term data comparing this technique to the standard surgical approach (Moskovitz, et al.,
2007; Sadove, et al., 2005).
Professional Societies/Organizations
American College of Obstetricians and Gynecologists (ACOG): In a Committee Opinion
(2017, reaffirmed 2020), ACOG recognizes that breast reduction surgery in adolescents with large
breasts can relieve back, shoulder, and neck pain. Recommendations for timing of surgery include
postponing surgery until breast maturity is reached, waiting until there is stability in cup size over