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Long-term Satisfaction of Adolescent Reduction Mammaplasty for Bilateral Symptomatic Macromastia
Jesse T. Nguyen, M.D.1, Humberto Palladino, M.D.2, Anne J. Sonnema3, Paul M. Petty, M.D.1.
1Mayo Clinic, Rochester, MN, USA, 2Texas Tech University Health Science Center, El Paso, TX, USA, 3Utrecht University, Utrecht, Netherlands.
PURPOSE: To study the long-term satisfaction of reduction mammaplasty for symptomatic bilateral macromastia in adolescent females.
METHODS: A mixed-mode mail and telephone surveyed 203 women who underwent reduction mammaplasty for symptomatic bilateral macromastia at our institution between 1985 and 2005. The subjects were younger than 21 years of age at the time of surgery and currently 5 to 25 years older. The survey addressed postoperative complications, symptom resolution, success and overall satisfaction. Ninety-nine patients responded (48.8%). Our survey research center distributed surveys and performed descriptive statistics.
Mean operative patient age was 19.1 years (median 19.2, range 16.2 to 20.9). Mean follow-up was 15.6 years (median 15.1, range 6.0 to 26.4). Mean BMI was 27.2 kg/m2 (median 26.6, range 18.6 to 38.5). Fifteen surgeons averaged 6.6 operations. Mean weight of reduction on the left was 635.7 grams (SD ± 274.1, range 150.0 to 2095.0), and on the right was 626.4 grams (SD ± 272.7, range 180.0 to 2150.0).
The most common complication within the first week of surgery was bleeding at the surgical site (24.5%), however after the first month this complication was present in only 1%. Nipple deformation was the second most common complication in the first week of surgery (13.1%), but continued and was the most common complication after the first month (13.2%).
A variety of preoperative symptoms improved postoperatively. (Table I) Preoperative problems with feeling uncomfortable (98%), finding clothes that fit (94.9%), running (89.8%), and participating in sports (84.7%) were reported, with postoperative improvement seen in 87.5%, 86.0%, 83.7%, and 85.2%, respectively.
The most common long-term complications were prominent scarring (71.7%) and decreased nipple sensitivity (67.3%); however 56.5% reported that scarring had not affected them in any way. Difficulty breast feeding (65.2%) was also reported, most commonly secondary to decreased milk production (80.0%).
Over half of respondents (55.6%) felt that currently their breast were the appropriate size. Postoperative recurrence of breast enlargement was reported by 54.5%, however 74.2% also reported being pregnant, of which 75.0% reported breast enlargement with pregnancy. Of those pregnant, 74.5% reported postpartum resolution. The majority (93.9%) rated the overall success of their operation at least 50% successful, with 42.4% reporting 100% successful in treating their problems. Improved quality of life was reported by 88.7%. Knowing what they now know, 95.9% would have surgery again; 67.7% at the same age. A majority of respondents (66.7%) would definitely recommend this procedure to a friend or family member at the same age.
CONCLUSION: Adolescent patients suffer the same short- and long-term complications as adults such as wound healing complications, hypertrophic scarring, decreased nipple sensation, recurrent breast hypertrophy, nipple deformation, and inability to breast feed. It is important to provide comprehensive preoperative education to all patients. Long-term follow-up of reduction mammaplasty in the adolescent population shows excellent resolution of symptoms, good overall satisfaction, and improvements in quality of life that continue into adulthood.
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