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2005; Blomqvist, et al., 2004; Souto, et al., 2003; Collins, et al., 2002; Ayhan, et al., 2002;
Bruhlmann, et al., 1998).
Chadbourne et al. (2001) conducted a systematic review and meta-analysis of 29 studies of 4173
patients to determine whether reduction mammoplasty improves measurable outcomes in women
with breast hypertrophy. Experimental and observational studies were included; no randomized
controlled trials were found. Outcomes assessed were postoperative physical signs and symptoms
such as shoulder pain, shoulder (bra strap) grooving, and quality-of-life domains, such as physical
and psychological functioning, and were expressed primarily as risk differences. The mean body
mass index of the patients was 27.5 kg/m
2
in the observational studies and 29.6 kg/m
2
in the
experimental studies. The average tissue mass removed per breast was approximately 1400
grams. The authors concluded that reduction mammoplasty was associated with a statistically
significant improvement in physical signs and symptoms involving shoulder pain, shoulder
grooving, upper/lower back pain, neck pain, intertrigo, breast pain, headache, and pain/numbness
in the hands. The quality-of-life parameter of physical functioning was also statistically significant,
while psychological functioning was not significant. The evidence suggests that women undergoing
reduction mammoplasty for breast hypertrophy have significant postoperative improvement in
preoperative signs and symptoms, quality of life, or both.
Breast Reduction by Liposuction
Suction lipectomy or ultrasonically assisted suction lipectomy (liposuction) as a sole procedure has
been introduced as an alternative method in reducing breast size. The effectiveness of liposuction,
in terms of removing glandular breast tissue, rather than fatty tissue in the breast, remains to be
demonstrated. Evidence supporting the effects of this approach on patient outcomes has been
limited to retrospective/prospective uncontrolled studies and case series, and there are minimal
long-term data comparing this technique to the standard surgical approach (Moskovitz, et al.,
2007; Sadove, et al., 2005).
Professional Societies/Organizations
American College of Obstetricians and Gynecologists (ACOG): In a Committee Opinion
(2017, reaffirmed 2020), ACOG recognizes that breast reduction surgery in adolescents with large
breasts can relieve back, shoulder, and neck pain. Recommendations for timing of surgery include
postponing surgery until breast maturity is reached, waiting until there is stability in cup size over
6 months, and waiting until the age of 18 years. The committee states that the timing may be
reasonably determined by the severity of symptoms. It is also recommended that an assessment
of the adolescent’s emotional, physiologic, and physical maturity be conducted.
American Society of Plastic Surgeons (ASPS): In 2022, the American Society of Plastic
Surgeons convened a multidisciplinary work group consisting of members of the American Society
of Plastic Surgeons, the American Society of Breast Surgeons, the American Physical Therapy
Association, and a patient representative to revise the 2012 guidelines for reduction
mammaplasty. After evaluating the evidence-based literature, the work group made the following
recommendations with level of evidence and strength of recommendation (Perdikis, et al., 2022):
• post-menarche female patients presenting with breast hypertrophy should be offered
reduction mammaplasty surgery as first-line therapy over non-operative therapy based
solely on the presence of multiple symptoms rather than resection weight (high evidence
quality, strong recommendation)
• clinicians should counsel post-menarche patients with symptomatic breast hypertrophy
considering reduction mammaplasty that they may have a higher risk of complications if
they are older than 50 years old, have a body mass index greater than 35 kg/m
2
, or
require chronic corticosteroid use (all independent variables) (moderate evidence quality,
moderate recommendation)