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Reduction Mammaplasty Improves Quality-of-Life in Adolescents with Macromastia: A Longitudinal Cohort Study
Laura C. Nuzzi, BA1, Carolyn M. Pike, MPH1, Joseph M. Firriolo, MD1, Michelle L. Webb, PA-C1, Heather R. Faulkner, MD, MPH1, Erika M. Walsh, MD1, Amy D. DiVasta, MD, MMSc2, Brian I. Labow, MD1.
1Adolescent Breast Clinic, Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA, 2Adolescent Breast Clinic, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

PURPOSE:Macromastia, the benign overgrowth of one or both breasts, is a common condition with a well-documented negative impact on mental and physical health, self-esteem, and social functioning. Reduction mammaplasty during adolescence is relatively controversial; the psychological effects of treatment in this age group are largely unknown. This study seeks to measure changes in health-related quality-of-life (HRQOL) and breast-related symptoms following reduction mammaplasty in adolescents, and explore the effects of age and BMI category at time of surgery on postoperative quality-of-life outcomes.
METHODS: In this longitudinal cohort study, our group administered the Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), Breast-Related Symptoms Questionnaire (BRSQ), and Eating-Attitudes Test-26 (EAT-26) to 102 adolescents with macromastia and 84 unaffected female controls, aged 12 to 21 years. Patients with macromastia completed surveys preoperatively and postoperatively (at 6 months, 1 year, 3 years, and 5 years). Control subjects completed baseline and follow-up surveys at the same intervals. Higher scores in the SF-36, RSES, and BRSQ are associated with a better HRQOL, global self-esteem, and fewer/less severe breast-related symptoms, respectively. Higher scores in the EAT-26 are indicative of disordered eating thoughts and behaviors.
Mean age at the time of reduction mammaplasty was 17.9 ± 1.7 years. Patients with macromastia demonstrated significant score improvements postoperatively from baseline on the RSES, BRSQ, and in seven out of eight SF-36 domains (Table 1; p<0.001).

Postoperative subjects scored significantly higher than controls at follow-up on the RSES and in four SF-36 domains (physical functioning, bodily pain, social functioning, and mental health), when controlling for differences in baseline BMI category (p<0.05, all). Follow-up scores on the EAT-26, BRSQ, and in four SF-36 domains (role-physical, general health, vitality, and role-emotional) did not differ between the two groups (p≥0.05, all). Following reduction mammaplasty, the proportion of patients experiencing pain, bra strap grooving, inframammary intertrigo, and difficulty participating in sports and finding properly fitting bras/clothing was significantly lower than at baseline (p<0.001, all), with postoperative rates similar to those seen in control subjects (p≥0.05, all). Both younger (<18 years, n=54) and older patients (≥18 years, n=48) had significant postoperative improvements in RSES and BRSQ scores. On the SF-36, only older patients experienced a benefit in the mental health subscale (p<0.001). When the macromastia group was stratified by BMI category, both healthy-weighted (n=38) and overweight/obese patients (n=64) had significant postoperative improvements on the RSES and BRSQ, and six SF-36 domains. Unlike their healthy-weighted counterparts, overweight/obese patients did not have improvements in SF-36 general health (p=0.65).
Reduction mammaplasty was significantly associated with improvements in HRQOL and breast-related symptoms of adolescent patients. Postoperatively, patients report levels of well-being similar to, if not higher than, unaffected age-matched females. These results largely do not vary by BMI category or age. Patients and providers should be aware of the potential benefit of reduction mammaplasty for adolescents with symptomatic macromastia.

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