The Health-Related Consequences of Tuberous Breast in an Adolescent Population
Jonah I. Donnenfield*, Laura C. Nuzzi, Catherine T. McNamara, Brian I. Labow
Department of Plastic and Oral Surgery, Boston Children's Hospital/Harvard Medical School, Cambridge, MA
Tuberous breast (TBr) is a common yet poorly understood congenital breast difference that hinders breast growth during puberty. It is associated with lactation difficulties, and its mental and physical impact has not been formally studied in adolescents. The purpose of this study was to compare the physical and psychosocial effects of this condition on young women in relation to their unaffected, healthy peers.
Health-related quality of life surveys were administered to adolescent females with TBr and healthy female controls, aged 12 to 21 years of age. Surveys included Short Form-36v2 (SF-36), the Rosenberg Self-Esteem Scale (RSES), and the Eating Attitudes Test-26 (EAT-26). Age and BMI were compared between the two groups. Linear regression models, adjusted for BMI, evaluated the impact of TBr on survey scores.
Thirty-four affected patients and 264 control subjects were included. There was no difference in mean age, but BMI and BMI percentile were significantly higher in the TBr group. Across eight SF-36 domains, five were significantly worse in the TBr group compared to controls after adjusting for BMI. These domains included General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. TBr patients featured significantly lower scores on RSES and significantly higher scores on EAT-26.
Tuberous breast is associated with higher BMIs and predisposes adolescents to worsened mental health and lower self-esteem while increasing their risk for disordered eating. It is imperative that healthcare providers understand the physical and psychosocial burden of tuberous breast and tailor care accordingly.
Demographic characteristics of patients with tuberous breast and healthy control subjects and regression models for the effect of tuberous breast on mean survey score.
| Tuberous breast (n = 34) | Control (n = 264) | P | ||
| Mean (SD) age, y | 16.7 (1.7) | 16.8 (2.8) | .78^a | |
| Mean (SD) BMI | 27.5 (4.2) | 24.2 (6.2) | < .001^a | |
| Mean (SD) BMI percentile* | 87.3 (10.7) | 67.2 (25.9) | < .001^a | |
| BMI Category, n (%) | < .001^b | |||
| Underweight | 0 (0%) | 2 (1%) | ||
| Healthy | 9 (26%) | 177 (67%) | ||
| Overweight | 17 (50%) | 48 (18%) | ||
| Obese | 8 (24%) | 37 (14%) | ||
| Race/Ethnicity, n (%) | .01^b | |||
| White | 18 (53%) | 157 (59%) | ||
| Black or African American | 2 (6%) | 46 (17%) | ||
| Asian | 0 (0%) | 8 (3%) | ||
| Hispanic | 3 (9%) | 12 (5%) | ||
| Other | 0 (0%) | 12 (5%) | ||
| Decline to answer/NA | 11 (32%) | 29 (11%) | ||
| P^c | P^d | |||
| SF-36 Domains, mean (SD) | ||||
| Physical Functioning | 86.8 (22.5) | 90.8 (20.6) | .29 | .59 |
| Role Physical | 85.2 (21.4) | 90.3 (16.9) | .11 | .15 |
| Bodily Pain | 77.4 (18.0) | 75.7 (18.4) | .62 | .60 |
| General Health | 70.6 (18.6) | 79.1 (18.5) | .01 | .04 |
| Vitality | 44.6 (16.2) | 51.2 (15.6) | .02 | .04 |
| Social Functioning | 71.0 (23.2) | 84.6 (20.7) | < .001 | .01 |
| Role Emotional | 70.8 (26.8) | 86.1 (18.9) | < .001 | < .001 |
| Mental Health | 65.0 (19.5) | 75.7 (18.0) | .001 | .01 |
| RSES, mean (SD) | 28.3 (6.5) | 33.7 (5.4) | < .001 | < .001 |
| EAT-26, mean (SD) | 11.4 (11.6) | 6.0 (6.9) | < .001 | .004 |
*Only applies to patients < 20 y of age (n = 33 and n = 221 for above groups, respectively).
a Two-sided P value for independent t-test.
b P value for Fisher exact test.
c P value for linear regression coefficient (?), unadjusted.
d P value for linear regression coefficient (?), adjusted for BMI category.
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