Anthropometric Changes in a Prospective Study of 100 Patients Requesting Breast Reduction

Abstract

Background: The anthropomometry of the “ideal” breast is well described, but changes that occur with enlarged breasts are not. The aim of this study was to assess the prevalence of nipple asymmetry in the horizontal plane and changes in the inframammary fold (IMF) in patients presenting with macromastia (defined as excessive development of the mammary glands by Merriam-Webster dictionary). Methods: One hundred patients (200 breasts) presenting to the Plastic Surgery Clinic for bilateral breast reduction were enrolled in this study. Patients’ characteristics captured for this study included age, body mass index (BMI), and breast anthropometric measurements, such as suprasternal notch to nipple, nipple to IMF, IMF projected to cubital fossa, midhumeral point, and nipple measurement from meridian. Basic univariate statistical analyses were performed to evaluate the impact of nipple asymmetry. Results: The average age was 37 years (SD 12 years), and the median BMI was 33 (IQR 28–37). More patients presented with nipple asymmetry, of whom 45% were classified as lateral to the meridian, 19% were classified as medial to the meridian, and 36% were classified as central to the meridian. Patients with lateral asymmetry and medial asymmetry had a significantly higher BMI (median BMI 35) compared with patients with central positioning (median BMI 30). Increasing breast size was positively associated with nipple asymmetry, whereas BMI ( R = −0.30, P = 0.003) and macromastia correlated negatively with IMF position ( R = −0.38, P = 0.0001). Conclusion: In macromastia, nipple displacement from the breast meridian, especially lateral displacement, is common and is aggravated by an increase in BMI. The IMF also descends, and this is also more common in patients with a raised BMI. These changes have clinical implications.

Dealing with the Displaced Nipple–Areola Complex in Macromastia Using a Superomedial Pedicle and Inverted T Pattern

“… 3 They also reported IMF descent occurring with macromastia. They 3 and others 4 reported that the breast footplate migrates inferolaterally in patients with large breasts. In addition, displacement of the NAC from the breast meridian is not uncommon.…”

“…In addition, displacement of the NAC from the breast meridian is not uncommon. 3 , 4 There is surprisingly little literature dealing with the displaced nipple–areola complex in breast reduction, especially when using a superomedial pedicle. Furthermore, the pathogenesis of this condition has never been described and our postulate is noted below.…”

“…In contrast, it is suggested that with macromastia and particularly in patients with an raised BMI, 4 that all the breast perimeter ligaments attenuate 6 , 7 and the whole breast footplate is then expanded, especially the lateral aspect of the breast, which now extends into the axilla. This was evident in 9 patients in this study, who all had a BMI higher than 30.…”

“…This may explain why lateral NAC displacement occurs more commonly (12 of 15 in this study, 80%) than medial displacement in patients with a high BMI. 4 Hence, by elevating the medial aspect of the IMF superiorly, the nipple is repositioned in the breast meridian again. ( See Video [online] , which shows a patient with a laterally displaced NAC; by manipulating the medial aspect of NAC only, the NAC assumes a more central position.)…”

“…Brown et al 3 and others 4 have documented that there is descent of the inframammary fold (IMF) with macromastia, and that this is more prevalent with increasing body mass index (BMI). Hudson and Lelala 4 confirmed this finding, but also noted that in macromastia, the position of the nipple areola complex (NAC) is frequently not in the meridian of the enlarged breast. Their anthropomorphic study documented that 45% of patients who presented with macromastia have a laterally displaced NAC, whereas 20% have a medially displaced NAC.…”