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Background Macromastia significantly impairs females' quality of life, with treatments such as physical therapy (PT) often providing only temporary relief. Insurance routinely denies breast reduction surgery, despite little relief after conservative treatments. Research on the efficacy of PT for macromastia is limited. Objectives In this study, we investigated the efficacy of PT for macromastia and identified patient factors associated with progression to surgery. Methods We conducted a retrospective cohort study of patients with macromastia between 2017 and 2021. We collected data on presenting symptoms, attempted conservative treatments, PT duration, and whether surgery was performed. All patients were invited to participate in a survey regarding their symptoms, treatments, and responses to treatments. Symptoms associated with patients progressing to a breast reduction were evaluated with a multiple logistic regression. Results Among the 327 patients identified with macromastia, 312 (95.41%) reported back pain and 272 (83.18%) attempted PT. Of the 72 (22.02%) patients who responded to the survey, 152 (46.48%) underwent subsequent surgery. The mean time from initial consultation to surgery was 283 days. Bra strap grooving was associated with progression to surgery (odds ratio = 1.90, CI = 1.02-3.54). Mean patient-reported pain levels decreased after surgery compared to after PT (pre-PT = 7.1, post-PT = 7.1, post-surgery = 3.1, P <.001). Conclusions Patients frequently undergo PT before breast reduction surgery despite no significant reduction in pain, whereas those who undergo surgery experience permanent relief and significantly reduced pain. Patients with bra strap grooving are more likely to progress to surgery. The requirement for PT as a prerequisite for surgery by insurance companies should be reevaluated. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Dermatomyositis is a rare autoimmune disease characterized by muscle weakness and skin rashes. Management typically involves high-dose cortisone treatment, which raises concerns about the feasibility and safety of aesthetic surgeries for affected individuals. This case report presents a successful outcome of an aesthetic surgery conducted on a dermatomyositis patient undergoing high-dose cortisone therapy. The patient, a 39-year-old female with a history of juvenile dermatomyositis, expressed a desire for aesthetic improvement, first in the periocular area and then in terms of the appearance of her breasts. Despite the challenges posed by the underlying condition and ongoing corticosteroid treatment, the patient underwent elective aesthetic surgeries with meticulous perioperative care and close collaboration between the surgical, anesthetic, and rheumatology teams. The successful outcome of the procedures enhanced the patient's self-esteem and quality of life. This case underscores the importance of individualized treatment planning, interdisciplinary collaboration, and careful perioperative management for achieving favorable aesthetic outcomes for patients with dermatomyositis undergoing corticosteroid therapy for more than 20 years. Further research and awareness are warranted to guide the safe performance of aesthetic surgeries on this unique patient population. [ABSTRACT FROM AUTHOR]

Introduction: Breast hypertrophy, a common pathological condition, often requires surgical intervention to alleviate musculoskeletal pain and improve patients' quality of life. Various techniques have been developed for breast reduction, each with its own advantages and complications. The primary aim of this study is to evaluate the efficacy, safety, and patient-reported outcomes of the authors technique: the Superomedial-Posterior Pedicle-Based Reduction Mammaplasty. Material and Methods: A prospective study was conducted on 912 patients who underwent breast reduction surgery between November 2012 and July 2020. The surgical technique involved preserving all glandular tissue from the areola to the pectoralis major muscle using the superomedial-posterior pedicle. The patients' demographic data, operative details, complications, breast-related quality of life (measured using the Breast-Q questionnaire), and nipple–areola complex sensitivity were analyzed. Results: The average operative time was 62.12 ± 10.3 minutes. Complications included minor wound dehiscence (4.05%) and hematoma (1.2%), with no cases of nipple–areola complex necrosis. Nipple–areola sensitivity was fully restored in all patients at the 2-year follow-up. Patient satisfaction with the procedure was high with a statistically significant difference observed between pre- and postoperative scores (p < 0.001) of the Breast-Q questionnaire. Conclusion: Authors technique offers reliable vascularization and innervation of the nipple–areola complex and achieves satisfactory aesthetic outcomes. It is associated with shorter operative times compared to other techniques reported in the literature. The Superomedial-Posterior Pedicle-Based Reduction Mammaplasty represents a safe and effective method for breast reduction surgery, providing significant benefits to patients with breast hypertrophy. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Breast hypertrophy may cause significant suffering, such as back- and breast pain, painful shoulder groves, and eczemas. Furthermore, women with breast hypertrophy may have lower quality of life than women without breast hypertrophy. Although 50% of the women undergoing breast reduction in the US have body mass index (BMI) >30 kg/m2, the current standard of normality is based on studies focusing on women <40 years of age and BMIs <25 kg/m2. This study aimed to present reference values for breast measurements for women with obesity and to investigate the relationship between BMI loss and each breast measurement. One hundred and six women underwent laparoscopic Roux-en-Y gastric bypass in Gothenburg, Sweden. The participants' breast anthropometrics were measured before and after bariatric surgery and their perception of the skin on their breasts was measured using the Sahlgrenska Excess Skin Questionnaire. Breast volume, sternal notch to nipple (SNN) distance, and ptosis increased significantly with increasing BMI. For instance, women with BMIs between 30–34.9 kg/m2 have a mean breast volume of approximately 770 ml, those with BMIs of 40–44.9 kg/m2 have approximately 1150 ml, and those with BMIs above 50 kg/m2 have approximately 1400 ml. Furthermore, the percent change in the respective breast measurements relative to percent BMI change can be predicted, for instance, with a 20% reduction in BMI, the breast volume, SNN-distance, and ptosis decrease by 25%, 4%, and 20% respectively. This article presents the first standard of normality for breast anthropometrics in women with obesity and a model for predicting the change in breast anthropometrics relative to BMI. This is a longitudinal observation study, registered https://fou.nu/is/gsb/ansokan/49651 , No: VGFOUGSB-49651. Trial registry name: "Överskottshud efter överviktskirurgi – dess utveckling samt behov och effekt av plastikkirurgi" ("Excess skin after bariatric surgery – its development and the need and effect of plastic surgery"). [ABSTRACT FROM AUTHOR]

Background: Breast hypertrophy causes physical and psychological symptoms. Reduction mammaplasty is a surgical procedure to lessen discomfort. However, there is a dispute about whether the weight of breast resection is related to body weight. This study aims to provide Chinese data and assess the association between body weight and removed weight in women undergoing reduction mammaplasty. Methods: Retrospective data were collected from 1777 breasts in a single center in 17 years. Simple linear regression analysis was performed to establish whether removed weight and removed weight ratio (removed weight/body weight) correlated with the body weight. The correlations were then analyzed again after grouping according to the removed weight. Results: For all breasts included, removed weight or ratio positively correlates with body weight. When the removed weight is more than 1000g, there is no statistically significant correlation between body weight and removed breast weight. When removed per breast weight is more than 600g, there is no correlation between body weight and removed breast weight ratio. Conclusions: The correlation between body weight and removed weight or ratio decreased with increasing removed weight. When removed weight >600g, the degree of breast hypertrophy is not related to body shape. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Bilateral breast hypertrophy, ranging from mild to severe, can lead to various complications, including pain, ulceration, infection, and psychological distress. Swift surgical intervention is often necessary to address the mechanical and psychological challenges associated with excessive breast weight. While treatment approaches for this condition are debated, recent advancements favor surgical strategies like mastectomies with reconstruction to improve clinical and psychological outcomes. We present a unique case of bilateral breast hypertrophy successfully managed through breast amputation and NAC (nipple-areolar complex) graft using wise patterns incision mammoplasty. Case Presentation: This report details the case of a 30-year-old female with hypothyroidism and lupus who experienced significant bilateral breast enlargement during her second pregnancy. The patient faced pain, hyperpigmentation, and limited mobility, along with abnormal laboratory findings. Bilateral reduction mammoplasty (breast amputation) was performed, leading to successful outcomes and improved quality of life for both the patient and her newborn. Follow-up assessments showed no recurrence or complications postoperatively. Conclusion: This case highlights the challenges of managing breast hypertrophy in pregnant patients with autoimmune conditions. Early recognition and multidisciplinary management are crucial in such cases. The positive results of the interventions underscore the importance of timely and comprehensive care for patients facing similar conditions. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Gestational macromastia is a rare disorder involving excessive breast tissue enlargement during pregnancy, potentially threatening the fetus and the mother. Our patient's previous pregnancies were more physiological, without any associated symptoms. Moderate bilateral enlargement of the breasts is a normal finding during pregnancy and lactation. Occasionally, there is a continuity from this physiological hypertrophy to massive breast hyperplasia or gigantomastia, causing complications that threaten the wellbeing of the fetus and the mother or raising alarm for a malignant disease. We present a case of a 28‐year‐old G3P2L2 with a gestational age of 29 weeks complaining of massive bilateral breast enlargement for 6 months, accompanied by a threatened abortion. The masses began gradually after conception and increased gradually over time. Notably, the breasts had been unremarkable in her two previous pregnancies. The breast ultrasonography and mammography findings pointed to a benign neoplasm. Histopathology of the lesions reported bilateral ductal hyperplasia. Conservative management and close follow‐up were initiated. A cesarean section was performed due to cord prolapse, and a 1.3 kg male baby was extracted. Unfortunately, the neonate succumbed after 3 days due to apnea of prematurity. The patients' breast size subsided considerably with time. Unusually large tumors can cause alarm for other pathologies, such as breast cancer. The radiological tests should reassure the attending practitioner, and the histological examination should confirm the diagnosis. An understanding of the typical and atypical clinico‐pathologic characteristics of breast lesions occurring in pregnancy and lactation is essential for appropriate patient care. [ABSTRACT FROM AUTHOR]

La reconstitution des 2 piliers du sein jointifs au cours d'une plastie mammaire de réduction ou de traitement de la ptôse représente un temps essentiel pour définir un galbe du sein satisfaisant, pour éviter les désunions sous-mammaires en postopératoire, et contribuer à la projection de la plaque aréolomamelonnaire ainsi stabilisée. Les piliers du sein sont les deux colonnes glandulaires et graisseuses du segment III du sein ; ces piliers ont une épaisseur variable en fonction des habitudes du chirurgien mais également en fonction de la densité de la glande et de la graisse résiduelle que le praticien choisit de conserver pour reformater le sein. Leur réparation ou création est essentielle pour obtenir un joli galbe mammaire et une stabilité à long terme. The reconstruction of the 2 contiguous breast pillars during a mammoplasty for reduction or treatment of ptosis represents an essential time to define a satisfactory breast curve, to avoid sub-mammary disunions postoperatively, and to contribute to the projection of the nipple areola thus stabilized. The pillars of the breast are the two glandular and fatty columns of segment III of the breast; these pillars have a variable thickness according to the habits of the surgeon but also according to the density of the gland and the residual fat that the practitioner chooses to keep to reformat the breast. Their repair or creation is essential to obtain a nice breast curve and long-term stability. [ABSTRACT FROM AUTHOR]

Background: Reduction mammoplasty (RM) is an important procedure in the management of symptomatic greater breast hypertrophy with or without early-stage breast cancer. We aim to introduce a new procedure: the three-pedicle reduction mammaplasty technique. Methods: A prospectively maintained database was reviewed, and two prospectively registered clinical studies were included of all breast hypertrophy patients with or without breast cancer who underwent three-pedicle RM with inverted T incision at West China Hospital or the Fourth People's Hospital of Sichuan Province from 2018 to 2022. Patient demographics, patient-reported cosmetic results, quality of life (QoL), surgical outcomes and complications were assessed. Results: During a median period of 22.5 months, 101 reduction mammaplasties were performed (Mage= 35.80; MBMI= 27.05). Mean reduction weight was 880.9 g ranging from 423–1630 g per breast. The nipple-to-sternal notch distance (N-SN) at post-operation was significantly shorter than preoperatively (left, 34.51 cm; right, 34.69 cm). Major complications and minor complications were 1.9% (1/52 patients) and 13.5% (7/52 patients), respectively. Multivariate logistic regression analyses showed that BMI > 30 was independent risk factors for a complication. Except for sexual and physical well-being at 1-month post-operation, patients gave a higher score on the BREAST-Q (breast satisfaction, physical well-being, psychosocial well-being) after the operation than before the operation (P<0.001). Conclusions: The three-pedicle RM technique was demonstrated to be an effective and safe RM procedure for moderate to severe breast hypertrophy patients with or without breast cancer, with the advantages of removing the lesions, reducing hypertrophic breasts and accomplishing mammoplasty. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Dermatomyositis is a rare autoimmune disease characterized by muscle weakness and skin rashes. Management typically involves high-dose cortisone treatment, which raises concerns about the feasibility and safety of aesthetic surgeries for affected individuals. This case report presents a successful outcome of an aesthetic surgery conducted on a dermatomyositis patient undergoing high-dose cortisone therapy. The patient, a 39-year-old female with a history of juvenile dermatomyositis, expressed a desire for aesthetic improvement, first in the periocular area and then in terms of the appearance of her breasts. Despite the challenges posed by the underlying condition and ongoing corticosteroid treatment, the patient underwent elective aesthetic surgeries with meticulous perioperative care and close collaboration between the surgical, anesthetic, and rheumatology teams. The successful outcome of the procedures enhanced the patient’s self-esteem and quality of life. This case underscores the importance of individualized treatment planning, interdisciplinary collaboration, and careful perioperative management for achieving favorable aesthetic outcomes for patients with dermatomyositis undergoing corticosteroid therapy for more than 20 years. Further research and awareness are warranted to guide the safe performance of aesthetic surgeries on this unique patient population.

Gigantomastia is a rare pathologic condition characterized by an excessive and abnormal breast hypertrophy. To date, there is no exact definition or classification of this disease. Pathogenesis still unclear. The purpose of this article is to present a case of extreme and disabling gigantomastia caused by pseudoangiomatous stromal hyperplasia, one of the rarest etiology of gigantomastia. [ABSTRACT FROM AUTHOR]

Background and objective. Masculinizing chest surgery, or top surgery, is one of the main surgical treatments in the gender transition from female to male. This review aims to describe the mastectomy techniques in transgender patients with mammary hypertrophy and assess the advantages and disadvantages of each one. Methods. A narrative review was conducted through a search on Pub-Med, Google Scholar, and SciELO using the keywords: gender identity, hypertrophy, mastectomy, transgender persons, in Spanish, English, and Portuguese. Only articles that included masculinization of the chest in patients with mammary hypertrophy were selected for analysis. Results. The primary technique mentioned was the double transverse incision with the use of nipple-areola-complex (NAC) graft, which allows a wide operative field, treatment of the submammary groove, precise repositioning of the NAC, and, in its variants, the treatment of lateral skin redundancy. Another option for skin resection is the Wise pattern, which results in an inverted T-shaped scar difficult to conceal. Treating the NAC through grafting it is preferred to achieve a flatter chest compared to treatment with a pedicled NAC. Patient satisfaction was not standardized, making it difficult to compare outcomes. Conclusions. Although we did not identify an ideal technique universally applicable, we were able to synthesize the advantages and disadvantages of each technique providing a guiding framework in decision-making. [ABSTRACT FROM AUTHOR]

Immediate implant-based breast reconstruction in patients with large and ptotic breasts may be challenging due to skin redundancy. The use of a reduction mammoplasty pattern for the mastectomy skin excision has proven to be a reliable option for these patients as it allows for a better shape, projection, and symmetrization. This approach has been described in the literature for both one- and two-stage reconstruction with either sub- or pre-pectoral reconstruction with an acellular dermal matrix (ADM) or non-biological mesh. One-stage immediate breast reconstructions have a positive significant impact on patients' psychosocial well-being and quality of life. The purpose of this paper is to describe an institutional algorithm that allows one to perform one-stage implant-based breast reconstructions in patients with large and ptotic breasts. [ABSTRACT FROM AUTHOR]

Background: Norm values for patient reported outcomes, that is knowledge about how the general population of women rate their breast-related satisfaction and quality of life, are necessary to interpret the meaning of scores. The aims of this study were to create Swedish normative values for the BREAST-Q reduction/mastopexy module and to describe what healthy women are most satisfied/dissatisfied with regarding their breasts. Methods: A random sample of 400 women aged 18-80, currently living in Region Västra Götaland, were sent BREAST-Q reduction/mastopexy. Descriptive data are presented. Results: One hundred and forty-six women answered the questionnaire (36.5%). Mean total scores ranged from 48 to 78. No clear changes in scores could be seen with age and women with a high BMI seem to be less satisfied with their breasts. The participants were most satisfied with the appearance of the breasts when dressed, the appearance in the mirror dressed, the shape of the breasts with bra, and symmetry of size and most dissatisfied with appearance in the mirror naked and the shape of the breasts without a bra. Thirty to forty-five per cent of healthy women never or almost never feel sexually attractive. Among physical symptoms often described in breast hypertrophy, the most common among healthy women were lack of energy, pain in the neck, arms and shoulders, headache and difficulty performing intense physical activity. Conclusion: The norms for BREAST-Q reduction/mastopexy add another piece to the puzzle to what constitutes normal breast satisfaction and how surgical outcomes can be evaluated. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

(1) Background: Breast hypertrophy is a prevalent condition among women worldwide, which can affect different aspects of their quality of life. Uncertainty exists in the medical literature about recommendations for return to work after reduction mammaplasty procedures. The aim of this study was to assess the return to work after reduction mammaplasty for women with breast hypertrophy. (2) Methods: A retrospective cohort study composed of chart review of all reduction mammaplasties performed at a single institution due to breast hypertrophy was considered. Patients not in working life were excluded. Patients were divided into two groups based on the sick leave duration: normal versus prolonged. Prolonged sick leave time was defined as times greater than the 75th percentile for the respective sample data. Demographic and comorbidity data were secondary predictor variables. The primary outcome measure was the occurrence of prolonged sick leave. Secondary endpoints were specific wound healing complications and late complications. We further compare postoperative complications between patients who received a sick leave of 3 weeks versus the other patient cohort. (3) Results: From a total of 490 patients, 407 of them were employed at intake. Mean time to working return after reduction mammaplasty was 4.0 ± 0.9 weeks. Prolonged sick leave occurred in 77 patients and its mean duration was 5.5 ± 0.9 weeks. No differences in age, preoperative BMI, smoking, comorbidities, number of children or use of herbal supplements were detected. Significantly increased intraoperative blood loss occurred in the group who received prolonged sick leave (328.3 mL vs. 279.2 mL, p = 0.031). Postoperative complications were significantly higher in the group who experienced a prolonged sick leave (26.5% vs. 11.2%, p < 0.001), particularly infections and wound dehiscence incidences. No differences in late complications were detected (>30 days, 6.5% vs. 7.6%, p = 0.729). When comparing patients who received a 3 week sick leave with the rest of cohort, blood loss was significantly higher in the group who had a longer sick leave (230.9 mL vs. 303.7 mL, p < 0.001). (4) Conclusions: The occurrence of postoperative complications increased the patients' return to work time. Comorbidities and preoperative parameters did not affect the length of sick leave. It appears reasonable to suggest a recovery period of approximately 3 weeks, subject to individual variations. An increased intraoperative blood loss might predict a prolonged sick leave. [ABSTRACT FROM AUTHOR]

Gigantomastia is a rare condition characterized by excessive breast enlargement, which can lead to physical and psychological distress. Gestational gigantomastia (GG) occurs during pregnancy, often presenting significant management challenges. This case contributes to the limited literature on GG management by highlighting the successful use of the Goldilocks technique combined with free nipple grafting, offering insights into an effective surgical approach. A pregnant woman presented with severe GG. She underwent bilateral skin-sparing mastectomy and immediate reconstruction using the Goldilocks technique with free nipple grafting. The intervention provided both functional and aesthetic outcomes, significantly improving the patient's quality of life. This case underscores the effectiveness of modern reconstructive surgical techniques in managing GG, particularly in complex cases where hormonal therapy is insufficient., Competing Interests: The authors declare that they have no competing interest.

Adolescence is defined as the period extending from puberty to adulthood, the limit of which is difficult to determine. It is a delicate period, in which the distancing from one's own body image can have deleterious consequences on psychological development and social-emotional life. Breast hypertrophy and the correction of hypertrophic tuberous breasts in adolescents raise some questions that we will attempt to answer in this article. There are specificities to manage, in relation to surgical indications, resection volume, postoperative follow-up and cutaneous healing. [ABSTRACT FROM AUTHOR]

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Abstract Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.

Objective To observe the clinical efficacy of reduction mammaplasty by modified double-ring incision in the correction of breast hypertrophy and breast ptosis. Methods From September 2017 to January 2022, 31 patients (62 breasts) underwent reduction mammaplasty by modified double-ring incision. The dermal vault was prepared during the operation and the excision range of parallelogram gland was designed. The dermal vault was used to fix the gland and the incision was sutured. Results All patients were followed-up for 5 to 12 months. No severe complications occurred. The breast shape was significantly improved, the scar was concealed and the efficacy was satisfactory. Conclusion The efficacy of reduction mammaplasty by modified double-ring incision in the correction of breast hypertrophy and breast ptosis was good. The breast shape after operation was good and the incidence of complications was low. It should be considerable for clinical popularization and application. [ABSTRACT FROM AUTHOR]

Background Gigantomastia has been described as excessive hypertrophy of the female breast, however, there is controversy about the weight of the excised tissue. In the literature, resected tissue amount between 1,000 g and 2,000 g per breast is reported as gigantomastia. Aims: The aim of this study is to evaluate the results of the patients who underwent reduction mammaplasty with a resection amount of at least 1,000 g or above via inferior pyramidal pedicle breast reduction technique retrospectively. Patients and methods: Between September 2015 and September 2018, 72 patients operated for gigantomastia were included in the study. All patients underwent reduction mammaplasty by inferior pyramidal pedicle and inverted Tscar technique. The pedicle base was not detached from the posterior region of the pectoralis fascia. Patient demographics, advantages, drawbacks and results of this technique were analyzed. All procedures were performed at a single institution by the senior author of this article. Results: The most common complication was hypertrophic scar (4.16%). At least 1-year follow-up revealed satisfactory results in terms of both esthetic and functional aspects. The average satisfaction rate was 88% (score: 4.38 = satisfied/very satisfied). Conclusion: Inferior pyramidal pedicle technique is a versatile reduction mammaplasty technique that can be applied in various breast sizes. It provides important advantages of preserving the nipple sensation and lactation potential with low complication rates.

Large and heavy breasts, termed macromastia, is a common cause of neck and back pain in females that may present as early as puberty. With focus usually elsewhere, macromastia is not usually a primary consideration when a patient initially presents to a spine specialist, particularly a spine surgeon. Axial pain is among the most common indications for breast reduction by plastic surgeons. Breast reduction surgery has been demonstrated to be an effective treatment for many women with back pain from macromastia. Awareness among spine specialists may prevent unneeded spinal intervention prompted by an overestimation of the contribution of vertebral degenerative changes to axial pain in affected women. This review aims to broaden spine providers' understanding of macromastia and its evaluation and treatment, including the role of breast reduction surgery to lessen axial pain., Competing Interests: Declaration of Competing Interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire. Methods: Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant. Results: Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m2. Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001). Conclusions: In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction.Methods: A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible.Results: Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%.Conclusion: There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified.Pre-registration: The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden. [ABSTRACT FROM AUTHOR]

Gigantomastia has been described as excessive hypertrophy of the female breast, however, there is controversy about the weight of the excised tissue. In the literature, resected tissue amount between 1,000 g and 2,000 g per breast is reported as gigantomastia. Aims: The aim of this study is to evaluate the results of the patients who underwent reduction mammaplasty with a resection amount of at least 1,000 g or above via inferior pyramidal pedicle breast reduction technique retrospectively. Patients and methods: Between September 2015 and September 2018, 72 patients operated for gigantomastia were included in the study. All patients underwent reduction mammaplasty by inferior pyramidal pedicle and inverted Tscar technique. The pedicle base was not detached from the posterior region of the pectoralis fascia. Patient demographics, advantages, drawbacks and results of this technique were analyzed. All procedures were performed at a single institution by the senior author of this article. Results: The most common complication was hypertrophic scar (4.16%). At least 1-year follow-up revealed satisfactory results in terms of both esthetic and functional aspects. The average satisfaction rate was 88% (score: 4.38 = satisfied/very satisfied). Conclusion: Inferior pyramidal pedicle technique is a versatile reduction mammaplasty technique that can be applied in various breast sizes. It provides important advantages of preserving the nipple sensation and lactation potential with low complication rates. [ABSTRACT FROM AUTHOR]

Elastofibroma dorsi (EFD) is a rare, benign, soft tissue tumor with an unclear pathogenesis, typically localized to the subscapular region. It occurs within the periscapular area between the ribs and dorsal chest wall muscles. Repetitive microtrauma by friction between the lower part of the scapula and the thoracic wall may cause reactive hyperproliferation of the fibroblastic tissue. This view has been supported by the higher prevalence of EFD, particularly among individuals who perform hard manual labor. EFD can, however, also be observed in those who have never performed hard manual labor and particularly in women over the age of 50. In this report, we present a case of bilateral EFD in a 52-year old woman with bilateral hypermastia, and examine the possible correlation between hypermastia and EFD.

Background: Research regarding quality of life (QoL) among women who have undergone breast aesthetic surgery is expanding. A comparative, anonymous study between the two main breast aesthetic procedures is needed.Objectives: The authors compared patient characteristics and aspects of QoL among women who underwent breast enlargement with implants (BI group) and those who underwent augmentation mastopexy (AM group).Methods: Patients at the Oslo Plastic Surgery Clinic were given a 47-question survey to measure QoL. The survey was anonymous; 61 patients who received breast implants and 37 patients who underwent augmentation mastopexy between 2005 and 2009 responded. Answers were processed by a QuestBack return mail system and sent to the authors. Statistical analyses were performed to evaluate significance between the groups.Results: The response rate was 67% in the BI group and 88% in the AM group. Mean follow-up time was 2.8 years in both groups. Motivation for surgery was primarily cosmetic (65%) and emotional (48%) in the BI group as well as cosmetic (78%) and physical (31%) in the AM group. The effects on psychosocial aspects were significant in the BI group regarding life changes and feeling like a "whole" person (68.9% vs 40.5% and 73.8% vs 40%). BI group also had a significantly higher satisfaction with overall cosmetic result, enlargement, and breast volume (93.4 %, 90.2%, 80% vs 69.4%, 70.2% vs 67% in AM group). Additionally, the BI group was more satisfied with shape, scar, and symmetry (90.1% vs 63.9%, 70.6% vs 40.5%, and 83.6% vs 54.0%, respectively).Conclusions: None of our patient groups were stereotypical and motivation for surgery was primarily cosmetic in both groups. BI patients were significantly more satisfied with the aesthetic outcome and the QoL of many psychosocial aspects. AM patients may have had different expectations than BI patients and a significant dissatisfaction was reported in shape, scarring, symmetry, and the nipple-areola complex.Level Of Evidence3: [ABSTRACT FROM AUTHOR]

Background: There is a lack of published, validated questionnaires for evaluating psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery. Aim: To validate the breast evaluation questionnaire (BEQ), originally developed for the assessment of breast augmentation patients, for the assessment of psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery. Study design: Validation study Subjects: Women with macromastia Methods: The validation of the BEQ, adapted to breast reduction, was performed in several steps. Content validity, reliability, construct validity and responsiveness were assessed. Results: The original version was adjusted according to the results for content validity and resulted in item reduction and a modified BEQ (mBEQ) that was then assessed for reliability, construct validity and responsiveness. Internal and external validation was performed for the modified BEQ. Convergent validity was tested against Breast-Q (reduction) and discriminate validity was tested against the SF-36. Known-groups validation revealed significant differences between the normal population and patients undergoing breast reduction surgery. The BEQ showed good reliability by test-re-test analysis and high responsiveness. Conclusion: The modified BEQ may be reliable, valid and responsive instrument for assessing women who undergo breast reduction. [ABSTRACT FROM AUTHOR]

Background: Body image dissatisfaction is one of the major factors that motivate patients to undergo plastic surgery. However, few studies have associated body satisfaction with reduction mammaplasty.Objectives: The aim of this study was to evaluate the impact of breast hypertrophy and reduction mammaplasty on body image.Methods: Breast hypertrophy patients, with reduction mammaplasty already scheduled between June 2013 and December 2015 (mammaplasty group, MG), were prospectively evaluated through the body dysmorphic disorder examination (BDDE), body investment scale (BIS), and breast evaluation questionnaire (BEQ55) tools. Women with normal-sized breasts were also evaluated as study controls (normal-sized breast group, NSBG). All the participants were interviewed at the initial assessment and after six months. Data were analyzed before and after six months.Results: Each group consisted of 103 women. The MG group had a significant improvement in BDDE, BIS, and BEQ55 scores six months postoperatively (P ≤ 0.001 for the three instruments), whereas the NSBG group showed no alteration in results over time (P = 0.876; P = 0.442; and P = 0.184, respectively). In the intergroup comparison it was observed that the MG group began to invest more in the body, similarly to the NSBG group, and surpassed the level of satisfaction and body image that the women of the NSBG group had after the surgery.Conclusions: Reduction mammaplasty promoted improvement in body image of women with breast hypertrophy.Level Of Evidence2: [ABSTRACT FROM AUTHOR]

Hypertrophy of the breast (macromastia and gigantomastia) is a rare medical condition of the breast connective tissues. The etiology of this condition is still not clear; rarely, gigantomastia has been reported to develop in the setting of an autoimmune illness. We reported a case of a 37-years-old woman with undifferentiated connective tissue disease of 2-years duration presented with enlargement of breasts. The breast enlargment started at5 months of gestation. She successfully underwent reduction mammoplasty with free nipple graft. In the succeeding monthsthe level of antinuclear ANA remained stable. It is uncertain whether a positive antinuclear antibodies in gigantomastia is a casuative agent or an effect.

Background: Inferior pedicle and free nipple grafting are commonly used as breast reduction techniques for patients with breast hypertrophy and gigantomastia. Limitations of these techniques are, respectively, possible vascular compromise and total/partial necrosis of the nipple-areola complex (NAC). The authors describe the innovative inferocentral pedicled reduction mammaplasty (ICPBR) enhanced by preservation of Würinger's septum for severe hypertrophic breasts. Materials and Methods: Among 287 breast reductions performed between January 2001 and 2015, 83 (28.9%) macromastia and gigantomastia patients met the inclusion criteria (breast volume resection ≥400 g-sternal notch-to-nipple distance ≥33 cm) and were included in the study. Patients were stratified according to pedicle type: Group A (51 patients) underwent ICPBR with Würinger's septum preservation; group B (32 patients) underwent IPBR. Groups were compared for NAC vascular complications, surgical revisions, wound-healing period and patient satisfaction at a minimum 6-month follow-up assessed by a five-category questionnaire (breast size, shape, symmetry, texture and scars appearance), with five Likert subscales (1 = poor to 5 = excellent). Descriptive statistics were reported, and comparisons of performance endpoints between groups were performed using Chi-squared, Fisher's exact and Mann-Whitney U tests, with p value <0.05 considered significant. Results: Group A and group B had, respectively, a mean age of 48.3 ± 12.4 and 50.1 ± 11.7 years, mean BMI of 23.8 and 24.6, mean weight resected of 560 ± 232 g and 590 ± 195 g, mean sternal notch-to-nipple distance of 35.1 and 34.3 cm, average nipple elevation of 9.7 and 9.5 cm. Among group A and group B, NAC complication rates were, respectively, 6.2 and 24.2% ( p = 0.03), surgical revision rates were 33.3 and 60% ( p = 1.00), healing time was 15.90 ± 3.2 and 19.03 ± 5.9 days ( p = 0.002), and mean patient satisfaction scores were 19.9 ± 2.6 and 18.7 ± 3.4 ( p = 0.07). Conclusions: The ICPBR technique enhanced by Würinger's septum preservation was found to be a reproducible and effective procedure for hypertrophic breasted and gigantomastia patients, improving the reliability of the vascular supply to the inferior-central pedicle. The authors do believe this procedure should be regarded as an innovative and safe option giving optimal aesthetic outcomes in this demanding group of patients. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Elastofibroma dorsi (EFD) is a rare, benign, soft tissue tumor with an unclear pathogenesis, typically localized to the subscapular region. It occurs within the periscapular area between the ribs and dorsal chest wall muscles. Repetitive microtrauma by friction between the lower part of the scapula and the thoracic wall may cause reactive hyperproliferation of the fibroblastic tissue. This view has been supported by the higher prevalence of EFD, particularly among individuals who perform hard manual labor. EFD can, however, also be observed in those who have never performed hard manual labor and particularly in women over the age of 50. In this report, we present a case of bilateral EFD in a 52-year old woman with bilateral hypermastia, and examine the possible correlation between hypermastia and EFD. [ABSTRACT FROM AUTHOR]

Mammary macrosomia and mastoptosis are common breast deformities encountered in plastic surgery practice. Most of the patients urgently need to correct these deformities. However, the limitations of the existing methods cannot satisfy patients' expectations. Therefore, this article discusses the surgical design, blood supply of nipple-areolar complex, prevention of scarring, and the difficulties of achievement of a satisfactory long-term outcome. By reviewing and resolving these issues, the author hopes to illustrate that reduction mammoplasty and mastopexy are a touchstone for plastic surgeons. [ABSTRACT FROM AUTHOR]