Maintenance of Breast Size Reduction After Mastoplasty and Switch to a Protease Inhibitor-Sparing Regimen in an HIV-Positive Woman with Highly Active Antiretroviral Therapy-Associated Massive Breast Enlargement

Abstract

Fat distribution disorders are among the most frequent side effects of antiretroviral treatment. The pathophysiologic mechanism(s) for these events remains unclear, and a casual link to a specific drug or class of drugs is uncertain. The physical changes associated with the lipodystrophy syndrome can be divided into three major types: lipoatrophy or fat wasting; lipohypertrophy or fat accumulation; and mixed forms with atrophy and hypertrophy coexisting in different body regions. Fat accumulation can occur in one or more of several areas including dorsal-cervical and abdominal regions and breasts. Withdrawal of antiretroviral therapy does not seem to influence the stabilized lesions significantly, and no one of the therapeutic strategies adopted so far was capable to achieve substantial improvements. Here we describe the successful and lasting treatment of a massive and movement/posture-hampering breast hypertrophy with reductive mastoplasty.

Appearance-Related Side Effects of HIV-1 Treatment

“…Gervasoni and colleagues 40 reported the case of a woman suffering from a debilitating macromastia, both physically and psychologically, where reductive mastoplasty resulted in a marked improvement for the patient.…”

Case Report:Reduction Mammoplasty in an HIV-Positive Woman

“…They found that the quality of life is better in healthy HIV-positive patients than in patients with AIDS. 3 Only one prior case report of a breast reduction in an HIV positive patient has been described, by Gervasoni, et al 4 Side effects of HIV medications lead to typical fat redistribution, which has been previously documented. 5 Liposuction in HIV patients with lipodystrophic complications from protease inhibitors and antiretroviral medications has also been described.…”

“…4 This is, apparently, the first case report of a reduction mammoplasty in an HIV-positive patient in the United States.…”

Surgical Management of HIV-Associated Lipodystrophy

“…30 Less information is known about the surgical management of fat accumulation in HIV-associated lipodystrophy, especially in terms of the safety and efficacy of UAL, SAL, and direct excision. [33][34][35][36][37][38][39][40][41] Although a limited number of patient reports and case series describe successful removal of focal areas of lipohypertrophy, long-term follow up has not yet been established (Table 2). Combining the data from 11 studies, including this report, reveals 88 patients who underwent surgical removal of fat in the anterior neck, posterior neck, torso, and breasts.…”

“…For HIVrelated lipohypertrophy, however, less is known about the efficacy, safety, and long-term outcome of surgical resection. [33][34][35][36][37][38][39][40][41] The purpose of this article is to evaluate the role of ultrasonic-assisted liposuction (UAL) and suction-assisted lipectomy (SAL) in the management of HIV-associated lipodystrophy.…”