Breast reduction Presentation

Jamie Burt , MBBS,FRACS

*Breast ReductionJust misundertood?

*Breast reduction

*Misinformation –patients motivated by cosmetic concerns, appearance

*Misperception- large breasts don’t cause significant adverse physical symptoms

*Ignorance- real motivations leading women to seek breast reduction

*Prejudice- one person’s symptoms are more deserving than another ( pain from Arthritis of the hip/knee is more valid than pain from large breasts)

*Breast reduction

*Published peer reviewed research evidence which documents the true story about women seeking breast reduction surgery

* How many breast reductions are performed in Australia?

*2013/2014

*Approx. 4000 bilateral breast reductions/year in Australia

*900 in Victoria

*Stable ( no significant increase in numbers in recent years)

*Demographics

*Age ranges from 16 to 70 years

*Major group 35-60 years

*Smaller group 25-35 years

*Vast majority of women in working years ( vast majority are actively engaged in work force at time of seeking advice)

*My practice

*50-59= 35%

*40-49=25%

*30-39=25%

*20-29=5%

*60-69=5%

*Motivations for surgery

*Back Pain 88%

*Neck Pain 82%

*Shoulder grooves 88%

*Rashes under breast 46%

*Headache 64%

*Exercise intolerance 80%

*Lack of self esteem 88%

*Poor posture 87%

*Motivations for surgery-My

practice

*Neck pain

*Back pain

*Shoulder pain, strap marks

*Headaches

*Poor posture

*Rashes, infections under breasts

*Inability to exercise ,exercise intolerance

*Humiliation –work, socially, buying clothes, exercising, attending commitments with children

* Does breast reduction resolve symptoms?

*Statistically significant improvement in all symptoms is seen in all patient groups

*Reproduced in multiple studies which document – symptom reduction

*Resolution of pain

* Increased exercise tolerance

*Objectively documented improved posture (small studies but xray studies show improved spinal angles)

* Improved lung function (inspiratory capacity, maximal voluntary ventilation, peak expiratory flow rate )

*Patient satisfaction

*My practice 97% satisfaction

*92-97% - symptoms completely resolved or significantly improved in multiple published research studies

*Under reported benefits

*In addition to well documented improvements in musculoskeletal pain

*Functional improvements in headaches, sleep and breathing

*Psychological benefits – significant – statistically significant improvements is self esteem, sexual function, decreased reported levels of anxiety and depression

* Types of reduction and functional gains

2 broad categories of breast reductions performed

1.Inverted T ( anchor type) scar pattern – inferior pedicle,central mound,superomedial pedicle

2. Vertical techniques (lollipop )- no inframammary scar - superior,superomedial,lateral pedicle

* Types of reduction and functional gains

*Results from both techniques equal in terms of functional outcomes

*The purported benefits of vertical techniques are “reduced scar burden”

*Only issue with this is patient do not report scar burden as a concern – both techniques have extremely high satisfaction ratings

* Types of reduction and functional gains

*Interestingly whilst there is statistical evidence the greater the weight of breast tissue reduced the greater the benefit even smaller volume reductions ( 250g /side) result in significant improvement in symptoms

*Breast feeding after breast

reduction

* Breast feeding and Breast reduction

* What is normal?- The most recent ABS data suggests less than 40% of women who have not had a breast reduction breastfeed their babies for 3months and only 15% make it to 6months .

*The World Health Organistation recommends exclusive breast feeding for 6 months after birth (ie. only 15 % of Australian women reach that target). Australia rates well compared with other countries.

*Breast feeding after breast

reduction

*Multiple studies published looking at breast feeding after breast reduction (although small patient numbers)

*Report 60-77% of women wishing to breast feed after a variety of techniques were able to

*Only Australian data 18/19 patients were able to lactate after breast reduction

*Breast feeding after breast

reduction

*In fact one study reports in women who already had experience with breast feeding their capacity to feed increased after breast reduction

*Breast feeding after breast

reduction

*Outcomes for breast feeding after breast reduction mirror findings in the general population

*Critical elements are

*Encouragement from your doctors

*Access to quality enthusiastic support services ( lactation advisor)

*Breast cancer risk after breast

reduction

* Breast cancer risk after breast reduction

It appears breast reduction significantly reduces breast cancer risk

Epidemiological study of 33,000 Scandinavian women who had breast reduction showed 28% less than expected incidence of breast cancer.

In the group of women over 50 years,43% reduced incidence of expected cases of breast cancer.

Increased breast cancer risk is absolutely not an indication for breast reduction but it is reassuring that having a reduction likely lessens your risk

* Breast imaging after breast reduction

*Issues can arise with mammographic appearances of the breast tissue after breast reduction

*All women over 40 years should have mammogram preoperatively ( pick any unsuspected issues)

*Post op mammogram as a routine 12months postop

*Conclusions

*Breast reduction is a very misunderstood and misrepresented procedure

*Patients motivations for seeking surgery are overwhelmingly physical symptoms ( pain)

*Procedure is well documented to resolve patients primary symptoms ( musculoskeletal)

*Desirable side effects – functional gains in under appreciated areas- psychosocial health, exercise tolerance , respiratory function, decreased breast cancer risk

*Does not preclude chance to breast feed

http://www.breastreductionclinic.com.au