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Estrogen-containing Hormonal Contraceptives May Prevent Additional Breast Hypertrophy In Adolescents With Macromastia
Laura C. Nuzzi, BA, Gabrielle G. Massey, Tannishtha Pramanick, BA, Catherine T. McNamara, BS, Joseph M. Firriolo, MD, Brian I. Labow, MD.
Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

PURPOSE: Hormonal contraceptives (HC) are commonly prescribed in adolescents for a myriad of health benefits. However, providers worry that HC use in adolescents with macromastia (breast hypertrophy) may exacerbate breast growth. This study explores the association between HC use, its formulation, and macromastia severity.
METHODS: Symptomology and medication use were collected from both patients undergoing bilateral reduction mammaplasty and age-matched, female controls (12-21 years old). To account for differences in body habitus, degree of hypertrophy was calculated for each breast patient in which their total amount of breast tissue resected was divided by their body surface area.
RESULTS: A total of 756 subjects were included, with a 1:1 ratio of macromastia to control subjects. Although more controls used HCs (65% vs 37%; p<0.05), macromastia subjects were more often prescribed estrogen-containing HCs (85% vs 58%; p<0.05). Macromastia patients prescribed estrogen-containing HCs experienced less hypertrophy than all other breast subjects (p<0.05, all). Furthermore, macromastia patients using progesterone-only HCs had greater breast pain and more severe hypertrophy (p<0.05, all).
CONCLUSIONS: Macromastia patients who took progesterone-only HC types had greater breast hypertrophy and more breast pain, while those on estrogen-containing HCs had less severe hypertrophy than those not on any HC. Additional research is needed regarding the effect of exogenous progesterone on breast hypertrophy, and providers are encouraged to consider estrogen-containing HCs for their adolescent patients with macromastia when indicated.


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