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In patients with breast hypertrophy, excessive breast weight applies pressure on the thorax, which may disrupt the normal breathing. The purpose of this study is to evaluate the impact of the breast hypertrophy and reduction mammoplasty on respiratory function. A comprehensive search of 3 databases, PubMed, Ovid, and Scopus databases, was performed. "Mammoplasty" and "respiration or pulmonary function tests" were the keywords used to search for relevant articles. Ten studies involving 280 patients with breast hypertrophy were included in the final review. Seven articles demonstrated an increase in at least 1 pulmonary function test value after the surgery. This systematic review revealed that, preoperatively, pulmonary function test values of the patients are usually in the normal range. Nonetheless, reduction mammoplasty still improves lung function parameters. Additionally, patients with respiratory complaints felt improvement in their symptoms after the surgery. However, future studies are needed, as heterogeneity among studies was observed.

Excess breast volume can lead to changes in the postural pattern that may result in pain. This causes women to seek reduction mammaplasty, a surgical procedure that reduces breast volume and may provide relief from symptoms. The objective of this study was to evaluate whether reduction mammaplasty can influence the posture of women. The postures of women with breast hypertrophy were evaluated using postural assessment software and photographic recording performed on the day of surgery and 3 months after the procedure. After surgical breast reduction, the patients had statistically significant changes in their postural patterns related to the horizontal alignment of the anterosuperior iliac spines and the angle of the acromion and anterior superior iliac spines. The analysis of the results showed statistically significant data on postural changes in the patients 3 months after the surgical procedure.

This article will provide an overview on female breast development and focus on common abnormalities of growth, the emerging role of breast self-awareness, and discuss trends in the evaluation and treatment of the breast masses and disorders most often encountered in the female adolescent population.Although the embryology of breast development is unchanged, data are emerging on the role of environmental factors on the timing of puberty and thelarche. As breast development occurs, the role of breast self-awareness is also a new trend that allows teens to be cognizant of changes in their own breast and to become more comfortable with their own anatomy. Finally, when breast treatments are needed or desired, the timing of breast treatments is a subject that must be individualized.There are numerous conditions that can result from disruption of normal breast development. These resultant breast disorders are generally benign but can still cause emotional distress to both the patient and family. It is thus imperative that healthcare providers be educated on breast development, the common breast masses that occur in the adolescent population and be prepared to discuss breast self-awareness and shared decision-making in this population.

Vertical reduction mammaplasty using a superomedial pedicle is a well-accepted technique giving good results in mild to moderate breast hypertrophy. We describe modifications of the vertical reduction technique to achieve safe reductions even for very large breasts and minimize unsightly scarring, skin necrosis and poor shape. Over the past 4 years, 162 patients have undergone bilateral breast reduction using the vertical mammaplasty technique with a superomedial dermoglandular pedicle. We present a retrospective study of 23 cases of gigantomastia (reductions over 1100g) who underwent bilateral reduction mammaplasty, using our technique. The mean age was 49 years, BMIs ranged from 28 to 52 kg/m. The mean suprasternal notch-to-nipple distance was 40.5 cm on the right and 41.4 cm on the left. The average resection weight per breast was 1303 g on the right, and 1245 g on the left side. The suprasternal notch-to-nipple distance was reduced by between 13.2 and 36.0 cm (mean, 16.1 cm). Mean follow-up was 14 months. We observed a superficial infection in 2 patients, a deep hematoma in one patient, partial necrosis of the nipple-areola complex in 1, and 2 patients needed correction surgery due to dog-ear formation. By using the described modifications, the nipple and areola were safely transposed on a superomedial dermoglandular pedicle producing good breast shapes, while scarring and complications in vertical reduction mammaplasty for oversized breasts were effectively minimized.

This study assessed the health-related quality of life experienced by breast reduction patients using four reliable and validated health-related quality-of-life measures.Consecutive patients with breast hypertrophy completed the Health Utilities Index Mark 2, the Health Utilities Index Mark 3, and the Breast Reduction Assessment Value and Outcomes instruments (the Short Form 36, the Multidimensional Body-Self Rating Questionnaire Appearance Assessment, and the Breast-Related Symptom Questionnaire) at 1 week and 1 day before surgery and at 1, 6, and 12 months after surgery.For the 52 patients in the study, mean scores for all quality-of-life instruments increased from the preoperative assessments to the postoperative assessments. The mean quality-adjusted life years gained per patient because of the surgery was 0.12 during the 1-year follow-up period. There was a positive relationship (p0.001) between breast resection weight and body mass index. However, body mass index and tissue resection weight were not significantly associated with Health Utilities Index Mark 3 change scores (p0.05).Patients who undergo breast reduction experience an important improvement in health-related quality of life according to four established measures. The improvement is most noticeable between 1 day before surgery and 1 month after surgery, after which it stabilizes for up to 1 year. The health-related quality-of-life effect of the surgery translates into an expected lifetime gain of 5.32 quality-adjusted life years, which is equivalent to each patient living an additional 5.32 years in perfect health. The authors conclude that there is no justification for the ongoing restriction or denials of third-party payments based on body mass index.

Background: Breast hypertrophy is a common condition that can be associated with significant morbidity. Symptoms emphasized in the literature include physical problems such as pain, intertrigo, and exercise restrictions. The purpose of this study was to explore the suffering experienced by women with breast hypertrophy and to evaluate the importance of different symptoms. Methods: Twenty-one women with breast hypertrophy were divided into five focus groups guided by a facilitator. Open discussion was encouraged to generate a comprehensive list of symptoms experienced by women with breast hypertrophy. Subjects then completed an iterative process to determine the relative importance of each symptom. Conversations were recorded, transcribed, and analyzed using Nvivo software. Results: A weighted list of 45 dominant symptoms was created from an initial pool of 128. Physical pain symptoms predominated in the older age group, whereas younger women expressed more psychological symptoms. Difficulties experienced by these women transcended all aspects of their lives. Back, neck, and shoulder pain were considered most troublesome, followed by exercise difficulties, poor posture, and low self-esteem. Conclusions: This study provides insight into the burden of breast hypertrophy and has implications for the objective assessment of this condition in the clinical setting.

The purpose of this article is to introduce the measurement of utilities, or patient preferences, to the plastic surgery community. Specifically, the study demonstrated the development and validation of a utility measure for estimating the health-related quality of life in women with breast hypertrophy. Two self-administered instruments were developed, a Wheel and a Table. All subjects completed the utility assessments for their "current health" and again for "breast-related symptoms." The reliability of the instruments was assessed in repeat (test-retest) interviews of 47 women within 10 to 18 days. Utilities obtained with the new instruments were also compared with the performance of other validated utility assessment instruments, including a visual analogue scale, a computer-based instrument (U-Titer), and a preference classification system (EuroQol). Of the 47 women in the test-retest reliability study, 21 had experienced breast hypertrophy (13 had not had reduction surgery and 8 had undergone reduction mammaplasty). Mean utility values for breast-related symptoms among women with breast hypertrophy (n = 13) were: Table, 0.85; Wheel, 0.90; and U-Titer, 0.66. Current health utility scores were significantly lower for women with breast hypertrophy (n = 13), as measured by all instruments except the Wheel. The Table had good reliability and distinguished women with breast hypertrophy from those without. Although the Table provided higher utility values for the same health state compared with the computer-based interview (U-Titer), it is much less costly to implement. The Table is recommended as a reasonable alternative for use in multicenter studies of women with breast hypertrophy. The reported utility value for breast hypertrophy of 0.86 is much lower than predicted. It is comparable with the reported burden of living with other health conditions, such as moderate angina (0.90) and a kidney transplant (0.84).

Atypical duct hyperplasia of the breast is an unusual finding in the adolescent or young adult female. We report nine young women, ages 18-26 years (mean 21) with atypical duct hyperplasia. Clinical presentation was either breast hypertrophy treated by reduction mammoplasty (five patients) or a thickening or mass that was examined via biopsy (four patients). No focal abnormalities were present on gross examination other than two fibroadenomas in one patient. Microscopically, isolated hyperplastic ducts were scattered in a background of prominent stromal collagenization. Each case showed a continuum of ductal changes, from partial to complete involvement by micropapillary and laciform epithelial hyperplasia, which was sometimes markedly atypical. In four, lobules were poorly developed or not present in the available sections. During a follow-up of 5-68 months (mean 39), none developed breast carcinoma. Much longer follow-up is needed to determine if young women with atypical duct hyperplasia are at increased risk for subsequent development of breast carcinoma. Presently, no surgical or medical intervention is recommended, but such patients should perform breast self-examination and be monitored regularly by a physician.

In the last few decades, several surgical techniques have been presented to decrease the symptoms of breast hypertrophy by removing a specific amount of breast tissue and reshaping the breast. Reliable and objective breast volume determination could be a helpful pre- and intraoperative assistance for the surgeon to achieve an aesthetic result, especially in breast asymmetry. But thus far no generally accepted method exists. In this paper, the advantages and disadvantages of classical techniques for breast volume determination (anthropomorphic measurements, conventional 2D radiological imaging, Archimedean methods, moulding techniques, measuring devices, modern radiological imaging) are critically analyzed and compared to an innovative alternative technique using 3D surface imaging. The technical background of 3D surface imaging is presented, underlining the reliability and accuracy of this innovative breast volume determination technique. Furthermore, a comparison of 3D surface imaging with the classical techniques of breast volume determination reveals the more comprehensible and transparent character of the 3D surface imaging method that permits a non-invasive, risk-free, non-contact, non-deformable patient assessment and delivers high-resolution 3D virtual, colored models of the breast region. Precise and accurate pre- and postoperative 3D quantitative calculations of shape, volume, surface changes, symmetry, projection, swelling tendency, contour and deformation are feasible. Finally, postoperative follow-up examinations at close intervals and optimizations of the preoperative surgical planning are possible. The clinical applications in the field of plastic, reconstructive and aesthetic breast surgery show promising results, but further implementations in other related fields should be performed.

Symptoms of breast hypertrophy are discussed. Both physical and psychological indications for corrective procedures are related to patients' expectations. Shape is discussed in terms of the patient's preference, her activities, and her geographic and historic background. Two main techniques are described--the Arié-Pitanguy-Ribeiro technique with a dermis-fat flap, which is recommended for extremely ptotic breasts, and the oblique technique, which is preferred for rounder hypertrophic breasts. In small ptoses the original Arié vertical wedge excision technique is still indicated. All patients are treated by the Schwarzmann maneuver with preservation of the periareolar nerves and vessel network, and areola transposition at the end of the operation. No drains are used.

A 14-year-old girl presented with unilateral massive breast enlargement while the opposite breast had minimal development. A 565 gm tumor, benign cystosarcoma phylloides, was removed by wide local excision. The literature regarding the controversial tumor is reviewed. Methods of treatment for each category of cystosarcoma phylloides, based upon morphological criteria, are outlined and the prognosis discussed. The special problem of cystosarcoma phylloides in the adolescent is reviewed and treatment recommended.