Optimal Timing for Reduction Mammaplasty in Adolescents

Abstract

Background: Reduction mammaplasty effectively alleviates symptoms and restores quality of life. However, operating on adolescents remains controversial, partly because of fear of potential postoperative breast growth. This cross-sectional study provides surgeons with a method to predict the optimal timing, or biological “sweet spot,” for reduction mammaplasty to minimize the risk of breast regrowth in adolescents. Methods: The authors reviewed the medical records of women aged 12 to 21 years who underwent reduction mammaplasty from 2007 to 2019. Collected data included symptomology, perioperative details, and postoperative outcomes. Results: Four hundred eighty-one subjects were included in analyses and were, on average, 11.9 years old at first menses (menarche) and 17.9 years old at surgery. Six percent of subjects experienced postoperative breast growth. Breast size appears to stabilize considerably later in obese adolescents compared to healthy-weight and overweight patients, and breast growth in obese macromastia patients may not end until 9 years after menarche. Operating on obese women before this time point increased the likelihood of glandular breast regrowth by almost 120 percent (OR, 1.18; 95 percent CI, 1.11 to 1.26). Surgery performed less than 3 years after menarche, the commonly regarded end of puberty, increased the likelihood of glandular regrowth by over 700 percent in healthy-weight and overweight subjects (OR, 7.43; 95 percent CI, 1.37 to 40.41). Conclusions: Findings suggest that reduction mammaplasty age restrictions imposed by care providers and third-party payors may be arbitrary. Surgical readiness should be determined on an individual basis incorporating the patient’s biological and psychological maturity, obesity status, potential for postoperative benefit, and risk tolerance for postoperative breast growth. Clinical Question/Level of Evidence: Risk, III.

Risk Factors Associated with Severe Macromastia among Adolescents and Young Women

“…18 Moreover, our macromastia severity value calculation normalizes breast resection mass to body surface area, and therefore minimizes the likelihood of large body habitus confounding our assessment of hypertrophy severity. 11 The role of adipose tissue as an important endocrine organ cannot be discounted. Research investigating gynecomastia (male breast hypertrophy) demonstrates that increased amounts of adipose tissue may lead to excess aromatization of androgens and a downstream elevation of local estrogen production, stimulating mammary glandular proliferation.…”

“…Using the method developed by Nuzzi et al, 11 the total breast resection mass (in grams) recorded intraoperatively at the time of surgery was divided by each patient's body surface area (m 2 ) to yield a macromastia severity value (g/ m 2 ). This effectively normalizes measurements of breast hypertrophy with respect to patient body habitus.…”

Quantifying Surgical Complications for Reduction Mammaplasty in Adolescents

“…Interestingly, the authors also observed that breast size stabilizes considerably later in obese macromastia patients compared to healthy-weight or overweight women. 10 Although breast size stabilizes on average 3 years after menarche in healthy-weight and overweight patients, breast growth in obese macromastia patients may not end until 9 years after menarche. Performing reduction mammaplasty in young obese women before 9 years postmenarche was associated with a significantly higher odds of postoperative breast growth (OR, 1.19).…”

Body Mass Index (BMI) Impact on Anesthetic Safety among Adolescents Undergoing Bilateral Reduction Mammaplasty

“…[2][3][4][5][6][7] In addition, obesity increases the risk of macromastia severity in the adolescent and young adult populations. [5][6][7] The reasons for presentation, and the patient-reported outcomes following reduction mammaplasty, are similar in obese and healthy-weighted adolescents and young adults. 3 Unlike findings in the adult population, surgical complications following breast reduction in adolescence and young adulthood seem independent of body mass index (BMI) category as well.…”

“…Symptomatic macromastia has been strongly associated with obesity, with roughly twothirds of breast patients presenting for consultation being overweight or obese. [2][3][4][5][6][7] In addition, obesity increases the risk of macromastia severity in the adolescent and young adult populations. [5][6][7] The reasons for presentation, and the patient-reported outcomes following reduction mammaplasty, are similar in obese and healthy-weighted adolescents and young adults.…”