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Reduction Mammaplasty Improves Quality-of-Life for Adolescents with Macromastia: A Longitudinal Cohort Study
Laura C. Nuzzi, BA, Carolyn M. Pike, MPH, Felecia E. Cerrato, MPH, Michelle L. Webb, PA-C, Heather R. Faulkner, MD, MPH, Erika M. Walsh, MD, Amy D. DiVasta, MD, MMSc, Arin K. Greene, MD, MMSc, Brian I. Labow, MD.
Boston Children's Hospital, Boston, MA, USA.

Adolescent macromastia is associated with significant deficits in physical and psychosocial wellbeing. Although reduction mammaplasty improves breast-related symptoms and self-esteem in adults, concerns remain regarding surgical outcomes in younger women. This longitudinal cohort study was performed to evaluate whether reduction mammaplasty effectively alleviated the associated negative health-related quality-of-life (HRQOL) and breast-related symptoms of adolescents with macromastia.
Validated surveys were administered to adolescents with macromastia and unaffected female controls, aged 12 to 21 years, from 2008-2015: Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), Breast-Related Symptoms Questionnaire (BRSQ), and Eating-Attitudes Test-26 (EAT-26). Macromastia patients completed surveys preoperatively and postoperatively at 6 months, 1 year, 3 years, and 5 years. Controls completed baseline and follow-up surveys at the same time intervals. Baseline and most recent follow-up survey were used for analyses. Differences in pre- and postoperative survey scores were compared within-subjects using dependent t-tests. Linear regression models were fit to measure the effect of case status on baseline and follow-up survey scores, adjusting for differences in baseline BMI category.
From 2008-2015, 102 patients undergoing reduction mammaplasty participated in our study, with a median (IQR, range) follow-up time of 14.0 months (18.4, 6.0-63.6 months) and a mean age at surgery of 17.9±1.7 years. Concurrently, 84 female controls of similar age (p=0.10) were prospectively followed with a mean follow-up time of 25.8±14.2 months.
Postoperatively, macromastia patients demonstrated significant improvements from baseline on the RSES, BRSQ, and in the following seven SF-36 domains: physical functioning, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health (p<0.001 for all). Pre- and postoperative EAT-26 (p=0.15) and SF-36 general health domain (p=0.37) scores did not differ.
After reduction mammaplasty, subjects scored similarly to controls in the following four SF-36 domains: role-physical, general health, vitality, role-emotional (p≥0.05 for all). Postoperative improvements were so profound that patients scored significantly higher than controls on the follow-up RSES and in four SF-36 domains: physical functioning, bodily pain, social functioning, and mental health (p≤0.04 for all). This result stands in marked contrast to baseline comparisons in which controls scored significantly higher than macromastia patients in seven SF-36 domains, the BRSQ, and RSES (p<0.001 for all).
The macromastia group also had a significant reduction in breast-related shoulder, neck, breast, and upper and lower back pain following reduction mammaplasty (p<0.001 for all). Fewer postoperative macromastia patients reported bra strap grooving, inframammary intertrigo, difficulty finding fitted bras and clothing, and difficulty participating in sports than at baseline (p<0.001 for all). These postoperative rates of breast-related pain and symptoms were similar to or lower than those of controls at follow-up assessments.
Reduction mammaplasty significantly improves the HRQOL and breast-related symptoms of adolescent patients with macromastia. Measureable improvements in both physical and psychosocial wellbeing were noted following surgery. Surgically treated patients reported levels of wellbeing similar to, if not higher than, unaffected female adolescents roughly 1 year after surgery. Patients, parents, and providers should be aware of the potential positive impact that reduction mammaplasty can provide for adolescents with macromastia and consider early intervention.

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