Case 39 Breast Reduction



Victor A. King and Glyn E. Jones

Case 39 Breast Reduction

Case 39 A 40-year-old female presents with complaint of large, pendulous breasts which are causing back, neck, and shoulder pain.



39.1 Description




  • 40-year-old woman with mammary hypertrophy and Grade III ptosis



  • Breasts have reasonable symmetry; no evidence of skin breakdown



39.2 Work-Up



39.2.1 History




  • Age and symptoms




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



    • 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:




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



    • Bleeding diatheses or anticoagulation



    • Oncologic history




      • Personal and family history; risk factors for breast cancer



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



    • Social history: Smoking, alcohol, and illicit drug use



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



    • History of previous breast surgery and pedicles



39.2.2 Physical Examination




  • Current breast size, chest size, and symmetry




    • 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)



    • 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




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



    • The nipple is often larger in women with macromastia



    • Position, projection, symmetry, and mobility



    • Nipple sensation: General and two-point sensation



  • Regnault classification of breast ptosis (see Table 37.1)




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



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

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 39 Breast Reduction
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