Disease Description (Causes and Symptoms)
- Definition: Macromastia (gigantomastia) is a condition in which breast tissue and skin develop excessively, causing physical and aesthetic discomfort; when necessary, the size is reduced through reduction mammaplasty.
- Causes and pathophysiology: Genetic factors, weight gain (general obesity), hormonal changes (pregnancy and lactation, puberty), and changes in diet and lifestyle may be involved. Excessive breast tissue and increased subcutaneous fat and skin increase the breast load and cause persistent traction, resulting in symptoms associated with postural deformities.
- Main symptoms:
- Shoulder, neck, and lower back pain; postural imbalance (such as kyphosis)
- Skin marks and pain caused by bra straps
- Eczema and dermatitis under the breasts (in the fold area, due to friction and moisture)
- Difficulty breathing or shortness of breath (in severe cases)
- Activity limitations (difficulty exercising and choosing clothing), psychological discomfort (reduced self-confidence)
- Diagnostic summary: Mainly clinical examination (observation of breast size, position, and asymmetry) and medical history assessment. When necessary, imaging tests such as mammography and ultrasonography are performed to evaluate breast lesions and as preoperative examinations.
Treatment Methods
- Conservative treatment (nonsurgical)
- Symptom relief by wearing a supportive specialty bra (sports bra)
- Weight loss and postural correction, physical therapy (strengthening and stretching)
- Medications for pain control (such as nonsteroidal anti-inflammatory drugs)
- Management of dermatitis: topical antiseptics, antifungal/steroid ointments, etc.
- Surgical treatment (breast reduction surgery)
- Indications: When symptoms do not improve with conservative treatment, or when there is severe pain, functional impairment, skin complications, or a strong aesthetic need
- Surgical methods: Periareolar (circular), vertical incision (remodeling), and inverted-T (“ㅗ”-shaped/“ㄴ”-shaped) incisions may be selected according to the patient's breast size and degree of ptosis. Extremely large breasts may require full-thickness excision of the nipple and areola followed by reimplantation (full-thickness skin grafting).
- Anesthesia and hospitalization: General anesthesia in most cases, surgery lasting 3–4 hours or longer, and typically 1–3 days of hospitalization
- Preoperative tests and preparation: Basic blood tests, chest X-ray, electrocardiogram, mammography (ultrasonography if necessary), smoking cessation, and discontinuation of medications that increase bleeding risk, such as aspirin (recommended 2 weeks before surgery)
- Postoperative care: Timing of drain and suture removal (several days to 2 weeks), wearing a specialty bra for several months, resumption of daily activities and permission for light exercise within 1 week, and several weeks to several months for complete recovery
- Precautions (surgery-related and self-care)
- Smoking cessation is recommended (to reduce delayed wound healing and the risk of complications)
- Whether lactation function is preserved depends on the surgical method and extent of excision (breastfeeding may be impossible after very extensive reduction)
- Because breast volume fluctuates during menstruation, avoiding this period when scheduling surgery is recommended
- Scar care is necessary (steroid injections and scar treatment procedures may be considered for hypertrophic scars)
- Complications (possible)
- Bleeding, hematoma, infection, and delayed wound healing
- Decreased or altered nipple and breast sensation (mostly improves over time)
- Breast asymmetry, scars and keloids (hypertrophic scars), and necrosis of breast tissue (rarely)
- Inability to breastfeed (the possibility increases when the extent of excision is extensive)
- Prognosis
- Most pain, posture-related symptoms, and skin problems improve after surgery. Recurrence is possible with weight gain or pregnancy.
Checklist Before an Outpatient Visit (Including Preparation Items and Sample Questions)
- Items to bring (recommended)
- List of medications currently being taken (especially anticoagulants, aspirin, and hormones)
- Past medical history and surgical history, and allergy information
- Recent mammography, ultrasonography, or test results (copies, if available)
- Record of symptom changes (location, intensity, and duration of pain; photographs of skin symptoms, etc.)
- Recent weight changes, pregnancy and lactation history, and menstrual cycle information
- Examinations and evaluations during the outpatient visit
- Physical examination (breast size, position, skin condition, and lymph node examination)
- Imaging if necessary (mammography and ultrasonography), as well as basic preoperative blood tests, chest X-ray, and electrocardiogram
- Examples of basic questions you can ask yourself during the outpatient visit
- "Will the medications I am currently taking affect the surgery?"
- "Will I be able to breastfeed after surgery?"
- "How much pain and what recovery period should I expect after surgery?"
- "Where and how much scarring will remain? How will the scars be treated?"
- "What is the risk of complications, and what should I do to reduce it?"
Examples of Disease-Specific Questions
- "Based on my current breast size and degree of ptosis, which incision method (periareolar/vertical/inverted-T) do you recommend? What are the advantages and disadvantages of each method?"
- "Can you estimate the amount of tissue that will be removed during surgery and the possibility of breastfeeding (the possibility of preserving the milk ducts and nipple sensation)?"