Breast feeding after reduction mammaplasty performed during adolescence

Breastfeeding Ability After Breast Reductions: What does the Literature Tell us in 2023?

INTRODUCTION

Reduction mammaplasties are routinely performed on women of child-bearing age, yet there still exists some uncertainty regarding a patient's ability to breastfeed following the procedure. This is due to inconsistent definitions of "successful" breastfeeding, a variety of pedicles implemented, and inadequate follow-up in the published literature. Our aim was to summarize the current data and provide clear recommendations for counseling patients on expected breastfeeding outcomes following reduction mammaplasty.

METHODS

A systematic review and meta-analysis in accordance with the PRISMA guidelines was conducted. We included papers that reported proportion of breastfeeding ability following reduction mammaplasty.

RESULTS

We identified 33 papers that met our inclusion criteria. We found that women who undergo reduction mammaplasty are at a 3.5 times increased odds of not being able to breastfeed compared to controls. Overall, reduction mammaplasty patients have a breastfeeding success rate of 62%. The breastfeeding success rate for patients with inferior pedicles was 64%, superior pedicles was 59%, and lateral pedicles was 55%. No conclusions could be drawn regarding medial, central, vertical, and horizontal pedicles on breastfeeding ability.

CONCLUSION

Current data suggest that women undergoing reduction mammaplasty have an increased odds of unsuccessful breastfeeding when compared to similar women who have not undergone the procedure. Based on the current literature, pedicle type does play a role in rate of breastfeeding success, although there is a need for further research on the aforementioned pedicles. Physicians should be aware of the likelihood of successful breastfeeding following reduction mammaplasty so that patients can be more thoroughly counseled prior to a decision for surgery.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction Mammaplasty for Macromastia in Adolescents: A Systematic Review and Pooled Analysis

BACKGROUND

Reduction mammaplasty for macromastia is one of the most common operations performed by plastic surgeons. There remains hesitancy in operating on adolescents, as there is ongoing debate about breast regrowth and potential impact on breastfeeding. The goal of this study was to analyze these concerns by reviewing the current literature.

METHODS

A systematic review of MEDLINE, Scopus, and Google Scholar was conducted using the following terms: "breast reduction" or "mammaplasty" or "breast reconstruction" and "adolescent" or "youth" or "pediatric" or "child" or "teen." Primary outcomes were success of breastfeeding after the procedure and procedure-related complications.

RESULTS

Twenty-three studies (87 percent retrospective), consisting of 2926 patients with preoperative cup sizes of C to KK (mean, DDD), met inclusion criteria. Mean age at the time of surgery ranged from 16 to 21 years, with the youngest patient being 12 years old. The overall complication rate was 27.3 percent (95 percent CI, 14.4 to 42.5 percent). Minor complications (22.8 percent; 95 percent CI, 10.2 to 38.5 percent) were more common than major (4.2 percent; 95 percent CI, 1.6 to 7.9 percent). Eighteen percent of patients (95 percent CI, 2.2 to 43.8 percent) reported regrowth of their breast tissue postoperatively, with 2.7 percent (95 percent CI, 0.9 to 5.5 percent) undergoing a second revision mammaplasty. Fifty-three percent of patients (95 percent CI, 36.0 to 69.3 percent) did not attempt breastfeeding. Of those who attempted, 55.1 percent (95 percent CI, 34.4 to 74.9 percent) were successful.

CONCLUSIONS

Prospective data are lacking. Patient counseling should focus on encouraging a trial of breastfeeding, despite surgical history. One-fifth of adolescent patients may notice breast regrowth postoperatively; however, the amount of regrowth is likely small and unlikely to reexacerbate symptoms, as the rate of revision surgery is small.

A successful breastfeeding after vertical scar reduction mammaplasty with superior pedicle: A case report

Introduction

Most of patients undergo reduction mammaplasty for aesthetic or therapeutic reasons without consider the effect on breastfeeding function. Vertical scar mammaplasty with superior pedicle is expected to be a breast reduction procedure that can keep maintain the function of breastfeeding. This is the first recorded report of breastfeeding after vertical scar reduction mammaplasty with superior pedicle in Indonesia.

Presentation of case

A 23 years old woman presented to the outpatient clinic with enlargement of both breast for 3 years. Physical examination showed bilateral breast enlargement. No tenderness, nodules, nor axillary lymph node enlargement were found. The patient was managed with vertical scar mammaplasty with superior pedicle. The patient was followed up with complication of skin excess and scarring on the bilateral submammary folds. We performed excision and resection procedures to eliminate the skin excess and scars without further complications. The patient was married and gave birth to her first and second child after two and five years following mammaplasty. The patient was able to provide exclusive breastfeeding for both of her children.

Discussion

Vertical scar mammaplasty with superior pedicle surgery is a surgical technique that combines a superior pedicle for the areola and performs a central-inferior quadrant resection for breast reduction. It only takes the tissue and glands that are located in the lower quadrant and still maintains the surrounding tissue and glands. This technique also maintains the integrity of nipple-areola complex (NAC) which also important in the lactation process

Conclusion

Vertical scar mammaplasty with superior pedicle can be one of the superior techniques in breast reduction which can maintain the breastfeeding function thereby increasing patient satisfaction.

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Breastfeeding after Vertical Scar Reduction Mammaplasty with Superior Pedicle:

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This procedure only takes the tissue and glands that are located in the lower quadrant.

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By preserving the superior pedicle it can maintains the integrity of nipple-areola complex (NAC).

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Keep the breastfeeding function thereby increasing patient satisfaction.

The short scar three-block L-wing technique

INTRODUCTION

Numerous techniques have been proposed for the plastic surgical treatment of hypertrophic breasts. Challenges of the procedure include the preservation of vascular supply and sensitivity of the nipple areola complex (NAC), breast feeding, and an esthetically pleasing result.

OBJECTIVES

In the present preliminary report, we introduce a new technique called the three-block L-wing reduction mammaplasty that addresses the aforementioned difficulties.

MATERIALS AND METHODS

The three-block L-wing reduction mammaplasty with a thick hemispheric superiorly based NAC pedicle and a medial as well as lateral pillar was performed in a total of 60 patients.

RESULTS

Our technique increases both, vascular safety and the sensory supply to the NAC, as it conceptually decreases the need for dissection of breast tissue and skin. The incidence of fat necrosis and wound healing disorders may be reduced with this technique. Because the ducts of the breast-gland underneath the NAC are not dissected, this technique also promises a higher probability of regular breast-feeding. Finally, our technique permits a cosmetically pleasing round-shaped mound of the breast.

CONCLUSION

The three-block modification simplifies the procedure of the superior pedicle L-wing mammaplasty markedly. It may increase the esthetic as well as the functional outcome and decrease postoperative complications.

The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies

BACKGROUND

Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is particularly important given the benefits of breastfeeding.

OBJECTIVES

To determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success.

METHODS

Databases were searched up to September 5, 2017. Studies were included if they reported the number of women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total number of women who had children following breast reduction surgery, or the total number of women who attempted to breastfeed following surgery.

RESULTS

Of 1,212 studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies was highly variable. However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma), a clear pattern emerged. The median breastfeeding success was 4% (interquartile range (IQR) 0-38%) for techniques with no preservation, compared to 75% (IQR 37-100%) for techniques with partial preservation and 100% (IQR 75-100%) for techniques with full preservation.

CONCLUSIONS

Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.

The effects of Moufarrege total posterior pedicle reduction mammaplasty on breastfeeding: a review of 931 cases

BACKGROUND

Since its original description in 1979, the Moufarrege total posterior pedicle reduction mammaplasty technique has proven to be a safe and reliable procedure providing aesthetic and functional enhancement.

OBJECTIVES

To determine if the Moufarrege total posterior pedicle reduction mammaplasty affects successful breastfeeding.

METHOD

Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was given. Patients were asked about their ability to lactate and successfully breastfeed preoperatively and postoperatively. The t test and χ(2) test were used to compare means and categorical variables, respectively. Values were also compared with a sample of women (n = 2223) from the Quebec general population as collected by the Longitudinal Study of Child Development in Quebec (ELDEQ, 1998-2002).

RESULTS

A total of 931 patients (all women) underwent reduction mammaplasty during the study period at Jewish General Hospital, Montreal, Quebec, Canada (H.S.) or Hopital Hotel-Dieu, Montreal, Quebec, Canada (E.B. and R.M). There was a 62% response rate to the questionnaire. There were no statistically significant differences in the percentage of women able to lactate postoperatively vs preoperatively (98% vs 100%, respectively; P = .2). The percentage of women able to successfully breastfeed for 4 and 6 months was also not statistically different when comparing postoperative vs preoperative ability (4 months: 33% vs 44 %, P = .13; 6 months: 29% vs 28%, P = .77). The sample of women from the Quebec population did not differ statistically from those undergoing the Moufarrege breast reduction in terms of successful breastfeeding for 1, 2, 3, and 4 months (59% vs 67%, 52% vs 47%, 42% vs 41%, and 40% vs 33%, respectively).

CONCLUSIONS

The Moufarrege breast reduction technique is a reliable and safe procedure that does not seem to negatively affect the success of breastfeeding based on the results of our retrospective chart review and patient questionnaire.

LEVEL OF EVIDENCE

4.

Long-term satisfaction of reduction mammaplasty for bilateral symptomatic macromastia in younger patients

PURPOSE

There is controversy about performing reduction mammaplasty in younger patients. Although no studies show poor surgical outcomes, a paucity of data exists on long-term outcomes and satisfaction.

METHODS

A single center mixed-mode mail and telephone surveyed 203 women who underwent reduction mammaplasty for symptomatic macromastia between 1985 and 2005, who were <21 years of age at surgery. A total of 99 women responded (48.8%).

RESULTS

Mean operative patient age was 19.1 years (range, 16.2-20.9 years). Mean follow-up was 15.6 years (range, 6.0-26.4 years). Sustained long-term symptom resolution was highest with shoulder pain (94.7%), breast pain (92.0%), and intertrigo (88.6%). Improvements in feeling uncomfortable (87.5%), finding clothes that fit (86.0%), sports participation (85.2%), and running (83.7%) were reported. Patients reported self-perceived decreased nipple sensitivity (67.2%) and difficulties breast-feeding (65.2%). Prominent incisional scarring was reported by 71.7%; however, 56.5% reported that scarring had not affected them in any way. The majority (93.9%) rated the overall success of their operation as at least 50% successful; 42.4% reported 100% success in treating the problems. Improved quality of life was reported by 88.7%. Most respondents (66.7%) would definitely recommend this procedure to a friend or family member at the same age. Knowing what they know now, 95.9% would choose to have the surgery again. Subgroup analysis of patients <18 years of age (n = 23; mean age, 17.3 years) at the time of surgery revealed equivalent results.

CONCLUSIONS

Long-term follow-up of reduction mammaplasty in patients aged 16-20 years shows good overall satisfaction and improvements in quality of life.

Normal Breastfeeding after Breast Reconstruction in a Patient with Poland's Syndrome

BACKGROUND: Poland's syndrome is a rare congenital non-inherited anomaly that usually manifests itself during adolescence and is characterized by absence or deficient development of one of the breasts. To our knowledge, no case of breastfeeding after reconstruction surgery in patients with Poland's syndrome has been described. CASE REPORT: A 22-year-old female patient with Poland's syndrome underwent breast reconstruction. The procedure performed consisted of rotation of a myocutaneous flap harvested from the ipsilateral latissimus dorsi muscle, which was subsequently attached to the anterior thoracic wall to create a pouch and place a 300-ml round textured cohesive silicone gel-filled breast implant. 5 years later the patient got pregnant, and 1 year after delivery she is still breastfeeding normally with both breasts. CONCLUSION: Reconstruction surgery with the latissimus dorsi muscle and a prosthesis was shown to be a potential and safe solution to achieve improvement of breast symmetry and to provide confidence and comfort in relation to self-image and, moreover, the ability to breastfeed.

Vertical scar mammaplasty in gigantomastia: retrospective study of 115 patients treated using the modified lejour technique

Since 1996, the original technique of superior pedicle vertical scar mammaplasty described by Lejour has been modified by decreasing skin and glandular undermining, limiting liposuction, avoiding tight glandular stitches, and adding a small horizontal scar for very large breasts. Between 1996 and 2002, 115 consecutive patients underwent a bilateral reduction mammaplasty of more than 500 g per breast using the modified Lejour technique. The early, late, and delayed complications were studied according to four parameters: glandular resection, age, smoking habits, and body mass index (BMI). There was no difference in terms of complications according to the glandular resection. Patients with a high BMI were found to have a higher rate of wound dehiscence. The occurrence of partial areolar necrosis proved to be related to smoking habits. Patients younger than 20 years presented a lower rate of seroma. The modified Lejour technique has proved to be safe and effective for large breasts.

Lactation and breast-feeding ability following lateral pedicle mammaplasty

A retrospective study was undertaken to evaluate the ability of breast-feeding using lateral pedicle reduction mammaplasty. A standard questionnaire was sent to 72 patients who had been operated on at a fertile age. Data was collected regarding the duration and quality of preoperative and postoperative breast-feeding, difficulties while breast-feeding, reasons for discontinuation of breast-feeding or for not attempting to breast-feed, and postoperative subjective sensitivity. Thirteen of the women who replied to the questionnaire had given birth after surgery. The pressure threshold sensitivity of areola-nipple complex was measured in nine of the above cases. To preserve lactation, a technique leaving structures untouched within the pedicle with increased dimensions was used.Breast-feeding was considered successful in this study if it was performed exclusively, without supplementation, for two months. Seven women (54%) breast-fed successfully for between two and 14 months (5.8+/-1.3) following surgery. Two women (16%) were classified as unsuccessful and four women (30%) did not breast-feed at all. The success of breast-feeding was limited by nonsurgical factors including the influence of medical personal. Five of eight women (62%) who had children preoperatively improved their rate of breast-feeding after surgery. No correlation was demonstrated between measured sensitivity and breast-feeding (p=0.65). No significant correlation was found between the resected tissue and breast-feeding (p=0.08). No relation was observed between the duration of breast-feeding and the period between operation and partus.