Disease Description (Causes and Symptoms)
- Definition: Macromastia (gigantomastia) refers to a condition in which the breasts are abnormally large due to an excess of breast tissue (glands and fat) and skin. Breast reduction surgery (reduction mammoplasty) is performed to relieve symptoms and improve appearance.
- Causes: Genetic factors, weight gain (fat accumulation), hormonal influences (enlargement during puberty or pregnancy), and Westernized diet and lifestyle, among others. Rarely, gigantomastia caused by sudden systemic hormonal changes (gestational gigantomastia) may occur.
- Pathophysiology: Excessive growth of breast tissue and skin laxity increase the load of the breasts → traction-related changes in the shoulders, neck, and lower back; eczema (dermatitis) in scarred or skin-friction areas; and breathing difficulties or activity restrictions.
- Main symptoms: Neck, shoulder, and lower back pain; chest pressure and breathing discomfort; bra marks (pressure marks on the shoulder and scapular area); dermatitis under the breasts (eczema and discharge); dissatisfaction with exercise and appearance; and asymmetry between the breasts.
Treatment Methods
- Conservative management
- Weight control, wearing an appropriately supportive bra, physical therapy (posture correction and strengthening), and treatment of dermatitis (topical medication/hygiene).
- Pain control: Analgesics, physical therapy, and posture correction.
- Surgical treatment (standard treatment)
- Reduction mammoplasty: Under general anesthesia, breast tissue and excess skin are removed, and the nipple and areola are repositioned and the tissue is sutured.
- Common incision and reconstruction techniques: Periareolar, vertical (lollipop), and inverted-T. For very large breasts, free nipple grafting may be considered.
- Selection criteria: Breast size and degree of drooping, elasticity of the breast tissue, and whether preservation of breastfeeding is desired.
- Preoperative evaluation and preparation
- Basic blood tests, chest X-ray, electrocardiogram (especially for patients undergoing general anesthesia), and mammography (for breast cancer screening); avoid smoking and medications that increase bleeding risk, such as aspirin (2 weeks before surgery is recommended). Avoiding the menstrual period can help with evaluating breast size and reducing the risk of bleeding.
- Postoperative care
- Hospitalization for 1–3 days, pain control, removal of drains if necessary, removal of sutures within 1–2 weeks, wearing a special or sports bra for several months, light daily activities possible within 1 week, and following the surgeon’s instructions regarding strenuous exercise.
- Risks and complications
- Reduced nipple or breast sensation (usually improves), nipple or breast necrosis (especially when blood flow is poor), abnormal areola position, bleeding, hematoma, and infection; wound separation and delayed wound healing; scarring (hypertrophic scars or keloids); inability to breastfeed (especially with free nipple grafting); anesthesia-related complications; and, rarely, the need for revision surgery.
Outpatient Visit Checklist (Including Examples of Items to Bring and Questions)
- Items to bring
- A list of all medications currently being taken (including anticoagulants, aspirin, and herbal medicines)
- A record of previous surgeries, medical conditions, and allergies
- Recent breast examination results (mammography, ultrasound, etc.) and reports from other examinations, if available
- Symptom diary: Location and intensity of pain (pain scale), frequency of shortness of breath and dermatitis, and limitations in daily activities
- History of weight changes and plans regarding pregnancy and breastfeeding
- Items to explain to the doctor during the outpatient visit (basic)
- When the symptoms began and factors that worsen or improve them
- Severity of the pain and its impact on sleep and daily activities
- Breastfeeding plans (whether future pregnancy and breastfeeding are desired)
- Smoking status and recent weight changes
- Items to check before the examination
- Menstrual cycle (to accurately assess breast size, avoiding the menstrual period when possible is recommended)
- Medications to avoid (if surgery is planned, confirm whether aspirin, NSAIDs, and anticoagulants should be discontinued)
Examples of General Questions to Ask the Doctor
- "Is surgery essential in my case, or how likely is it that my condition will improve with conservative treatment?"
- "What degree of improvement in pain and posture, and what cosmetic results, can I expect from surgery?"
- "What are the major complications of surgery, and how often do they occur?"
- "Are there any medications I should take or avoid before or after surgery?"
- "How long will recovery take, and when can I return to daily activities (driving, returning to work, and exercise) after surgery?"
Examples of Condition-Specific Questions
- "If I want to become pregnant and breastfeed in the future, is there a surgical method that can preserve my breastfeeding function? (What are the possibility and risks of preserving the nipple and ducts?)"
- "In my case (considering breast size and degree of drooping), which incision and nipple-preserving technique would you recommend, and where would the scars be located?"
Note: Surgical indications, methods, and the likelihood of complications vary depending on the individual’s condition (breast size, tissue composition, medical history, and smoking status). Please consult the treating specialist during an outpatient visit and through preoperative examinations for an accurate diagnosis and treatment plan.