Age and symptoms

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  Back pain, neck pain, shoulder pain, shoulder grooving, skin moisture, infections, maceration, and breakdown along inframammary fold (IMF)

  
  
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  Physical or sexual embarrassment, limitations of physical activities secondary to pain or restricted range of motion, difficulty finding properly fitting clothing

Current and desired cup size

Lactation potential: Attempt to preserve, or delay surgery, until childbearing is complete

Past medical history, including:

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  Collagen vascular, skin, scaring, autoimmune disorders, obesity, and diabetes

  
  
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  Bleeding diatheses or anticoagulation

  
  
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  Oncologic history

  
  
  
  
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    Personal and family history; risk factors for breast cancer

    
    
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    Obtain baseline mammogram preoperatively in all women of average risk 40 years of age or older, or younger in those at high risk

  
  
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  Social history: Smoking, alcohol, and illicit drug use

  
  
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  Developmental, menstrual, and obstetric history, degree of breast involution, response to hormones, and future pregnancy plans

  
  
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  History of previous breast surgery and pedicles

Current breast size, chest size, and symmetry

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  The larger the thoracic circumference, the larger the breast per cup size (i.e., a size 40B breast is larger than a size 34B breast)

  
  
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  Measurements Fig 36.1, Table 36.2: Nipple-to-sternal notch, nipple-to-IMF, inter-nipple distances, and IMF position and symmetry

Location of fullness (e.g., lateral vs. pendulous)

Skin quality: Elasticity, thickness, striae, presence, and location of scars

Breast quality: Glandular, fatty, or fibrous

Nipple

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  Size: Ideal nipple diameter for a woman is 4 to 5 cm, depending on breast size

  
  
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  The nipple is often larger in women with macromastia

  
  
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  Position, projection, symmetry, and mobility

  
  
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  Nipple sensation: General and two-point sensation

Regnault classification of breast ptosis (see Table 37.1)

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  Based on position of nipple–areola complex (NAC) relative to IMF

Overweight patients should lose weight to ensure appropriate breast size post reduction