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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