From the Guidelines
Reduction mammaplasty is indicated for patients with symptomatic macromastia, which includes chronic neck, shoulder, and back pain, shoulder grooving from bra straps, and difficulty with physical activities, as supported by 1 and 1. The primary indications for reduction mammaplasty include:
- Chronic neck, shoulder, and back pain
- Shoulder grooving from bra straps
- Chronic intertriginous rashes or infections beneath the breasts
- Poor posture
- Difficulty with physical activities Most insurance companies require documentation of conservative management failure, including weight loss attempts, physical therapy, supportive brassieres, and pain medications, as mentioned in 1. Typically, insurers require removal of a minimum tissue amount based on the Schnur sliding scale, which correlates body surface area to breast tissue removal (usually 400-500 grams per breast), as referenced in 1. Additional indications include breast asymmetry correction, breast reconstruction following cancer surgery, and addressing psychological distress from body image concerns. Contraindications include active breast cancer, severe medical comorbidities precluding surgery, unrealistic expectations, and inability to understand surgical risks, as outlined in 1 and 1. The procedure is most commonly performed under general anesthesia, with various surgical techniques available depending on breast size, shape, and patient goals, as described in 1. Recovery typically requires 1-2 weeks off work, with restrictions on heavy lifting for 4-6 weeks. Potential complications include bleeding, infection, altered nipple sensation, asymmetry, poor scarring, and rarely, nipple-areolar complex necrosis, as reported in 1 and 1.
It's essential to consider the patient's overall health, medical history, and individual circumstances when making decisions about reduction mammaplasty, as emphasized in 1 and 1. A thorough discussion of the risks, benefits, and alternatives should be had with the patient to ensure informed decision-making, as recommended in 1 and 1. By prioritizing the patient's well-being and individual needs, healthcare providers can help ensure the best possible outcomes for those undergoing reduction mammaplasty, as supported by 1 and 1.
From the Research
Indications for Reduction Mammaplasty
- Reduction mammaplasty, also known as breast reduction surgery, is performed to alleviate physical and psychological symptoms associated with large breasts, such as musculoskeletal pain, headaches, and poor self-esteem 2.
- The procedure is commonly indicated for women with macromastia, a condition characterized by excessively large breasts that can cause discomfort, pain, and difficulty with daily activities.
Guidelines for Reduction Mammaplasty
- Patients should be chosen for reduction mammaplasty based on their acceptability as candidates for the procedure, rather than the amount of breast tissue to be removed 3.
- A comprehensive preoperative risk assessment is essential to minimize postoperative complications, particularly for patients with risk factors such as high body mass index (BMI), smoking, diabetes, and previous radiation therapy 4.
- Surgical techniques, including inferior pedicle, superomedial pedicle, and medial pedicle, should be selected based on individual patient needs and anatomy 4.
Pain Management and Postoperative Care
- Continuous local anesthetic infiltration using indwelling catheters can provide effective pain relief and reduce the need for intravenous narcotic analgesia and inpatient hospitalization 5.
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as adjuncts to manage postoperative pain, with most patients requiring less than 10 tablets of narcotic pain medication after surgery 6.
- Patient education and expectation management are crucial in optimizing postoperative pain control and minimizing the risk of opioid dependence 6.
Benefits of Reduction Mammaplasty
- Reduction mammaplasty can provide significant functional benefits, including improved musculoskeletal pain, headaches, sleep, and breathing, as well as psychological benefits such as enhanced self-esteem, sexual function, and quality of life 2.
- The procedure can also lead to increased exercise and reduced eating disorders in women with macromastia 2.