Reduction Mammaplasty Is a Functional Operation, Improving Quality of Life in Symptomatic Women: A Prospective, Single-Center Breast Reduction Outcome Study

Abstract

Breast hypertrophy creates a functional disability, adversely affecting quality of life because of disproportionate upper body weight. No study to date has prospectively shown or statistically proved (using validated questionnaires) the functional benefits of breast reduction surgery. Moreover, no study has quantified the physical findings seen in these patients. A prospective trial was designed to illustrate objectively the functional benefits of breast reduction surgery and answer the question, Does surgically removing breast tissue in symptomatic patients (regardless of amount of tissue removed) improve their physical disabilities related to breast hypertrophy, and in turn, improve their quality of life? Fifty-five consecutive patients with an average age of 38 years (range, 18 to 73 years) undergoing breast reduction surgery by the senior surgeon (L.A.C.) were recruited for this study. The North American Spine Society (NASS) Lumbar Spine Outcome Assessment Instrument was used to assess patients' disability, expectations for treatment, and satisfaction with treatment. The visual analogue scale was used to quantify pain intensity. Muscle strengths of the pectoralis major, pectoralis minor, rhomboid, middle trapezius, and lower trapezius muscles and postural measures were obtained. Information was collected preoperatively and 6 months postoperatively for comparison. The mean cumulative preoperative NASS Lumbar Spine Outcome Assessment Instrument disability score was 1.94 +/- 0.68, and the mean cumulative postoperative disability score was 1.16 +/- 0.35 (p = 0.0001); 96.1 percent of patients met expectations to a certain degree and, of these patients, 96 percent were very satisfied with their surgery. The mean cumulative baseline preoperative visual analogue score for all participants was 6.2 +/- 2.06, and their mean cumulative postoperative score was 0.53 +/- 0.88 (p = 0.0001). There was statistically significant improvement of muscle strength in the rhomboids, middle trapezius, and lower trapezius muscles (p < 0.001). All postural measures showed improvement postoperatively, with head translation and cranial rotation showing statistical improvement (p < 0.05). This single-center, single-surgeon breast reduction outcome study showed that the signs and symptoms of breast hypertrophy are definable in a consistent manner. By standardizing and quantifying preoperative and postoperative evaluations with validated questionnaires, validated pain scoring, and standardized muscle and posture testing, it was shown that breast reduction for symptomatic breast hypertrophy can effect a statistically significant improvement in these objective measures of pain, disability, muscle weakness, and poor posture.

Dores na coluna: avaliação em pacientes com hipertrofia mamária

“…Many times, this professional is unaware of the objective and subjective criteria for breast assessment, or even of the severity of breast hypertrophy effects on musculoskeletal system. Breast hypertrophy has been known and disseminated due to the aesthetic changes it causes on women; however, in addition to aesthetic changes, this can determine serious physical problems, which can damage these patients' health and quality of life (5) . Physical changes caused by increased breast weight are due to the change of patients' gravity center, leading to sharper physiological curves of the spine, with increased shoulder and cervical spine muscles tension (4) .…”

“…Physical changes caused by increased breast weight are due to the change of patients' gravity center, leading to sharper physiological curves of the spine, with increased shoulder and cervical spine muscles tension (4) . Previous studies evidenced that breast hypertrophy patients' major complaints, in addition to the aesthetic aspect, are musculoskeletal system pain, with the most common ones being back pain, and these symptoms have been constituting factors for indicating breast size reduction in those patients (3)(4)(5) .…”

“…The evaluation of spinal pain and restraints resulting from these symptoms in patients with breast hypertrophy, assessed from a patient's point of view, and using instruments of which measurement properties have already been tested, lends higher reliability to the study. There are a scarce number of studies published in literature addressing spinal symptoms in patients with breast hypertrophy, and the restraints resulting from these symptoms, using previously validated scales and questionnaires (3,5) .…”

“…The BMI for the group with breast hypertrophy was 25.8 kg/m 2 , characterizing overweight, but this is a common data among breast hypertrophy patients, and tend to be higher in more significant hypertrophies. This can be due to the fact that breast size is already a factor for a heavier weight, and to these patients presenting physical and emotional discomfort, restraining physical activities (4,5,15) . The Analogous Numeric Scale (NRS) is a simple and efficient method for assessing pain severity from a patient's perspective, and it is used in several medicine areas for assessing these symptoms in a disease or treatment responsiveness research.…”

“…Breast hypertrophy is described as an abnormal augmentation of the breasts, and it has been associated to the emergence of various symptoms related to musculoskeletal system, with spinal pain being the most frequent ones ( Figure 1). This kind of pain may range from a simple discomfort to functional disability, with frequent indications to surgical treatment for reducing breasts volume (3)(4)(5) . The source of these symptoms may be postural changes resulting from gravity center changes, a consequence of breast augmentation, which causes exacerbation of the physiological curves of the cervical, thoracic and lumbar spine, additionally to keep cervical and thoracic muscles highly tensioned (6) .…”