Obi C. Iwuagwu

Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.

The aim was to determine the effects of bilateral reduction mammaplasty on quality of life and psychosocial functioning in women with mammary hypertrophy.

Does reduction mammaplasty improve lung function test in women with macromastia? Results of a randomized controlled trial.

Background: To determine the effects of reduction mammaplasty on lung function in women with mammary hypertrophy (macromastia), a prospective, randomized, controlled trial was conducted at the Academic Surgery and Plastic Surgery Units, Castle Hill Hospital, Cottingham, United Kingdom. Methods: Seventy-three women who were referred for consideration of bilateral breast reduction surgery were randomized into either an early intervention group (surgery within 6 weeks) or a control group (surgery 6 months after recruitment). Each group had two sets of lung function tests: the intervention group had one before and one 3 months after surgery and the control arm had one test initially and a second test 4 months after randomization and before surgery. The main outcome measure was the lung function test. Results: Sixty-five patients completed the study. The mean age was 39 years (SD, 12 years); both groups were equally matched for age, smoking status, social class, and educational status. By independent t test, there was no significant difference in lung function in the two groups. Subgroup analysis of the intervention group demonstrated a positive correlation between specimen weight and forced expiratory volume/vital capacity, forced expiratory volume/forced vital capacity, peak expiratory flow rate, and forced vital capacity. A paired sample t test revealed a significant improvement in the percentage of forced vital capacity performed/forced vital capacity predicted. Conclusion: The improvement in pulmonary function following reduction mammaplasty correlates with specimen weight resected.

Effects of bilateral breast reduction on anxiety and depression: Results of a prospective randomised trial

We assessed the effects of bilateral breast reduction on anxiety and depression in women with mammary hypertrophy (macromastia). Seventy-three consecutive women referred for consideration for breast reduction were recruited. They were randomised to have either early operation (within six weeks of initial assessment) or delayed operation (within six months of recruitment). The Hospital Anxiety and Depression Score was given before randomisation and four months later. All 73 patients completed the study. The mean (SD) age was 39 (12) years. The groups were matched for age, smoking, social class, and educational achievement. There were highly significant improvements (p<0.001) in symptoms of anxiety and depression. Reduction mammaplasty significantly improved symptoms of clinical depression in women with macromastia.

Ultrasound guided minimally invasive breast surgery (UMIBS): a superior technique for gynecomastia.

The last 30 years has seen a shift in surgical treatment of breast diseases to less invasive, more conservative treatment options. The mammotome equipment was originally introduced as a diagnostic tool, but advances in technology have extended its role to therapeutic procedures. The mammotome device (8-gauge) is inserted through a cosmetically placed 4-mm scar and breast tissue is resected sequentially using a suction facility without the need to remove the biopsy device. This is done under ultrasound guidance. Operative morbidity and postoperative score for cosmesis and patient satisfaction were recorded prospectively. Patients were reviewed in the clinic after 6 to 8 weeks. Five patients (4 unilateral, 1 bilateral) with idiopathic gynecomastia were treated. Mean age was 41.8 years (range, 16–88 years) with a median procedural time of 32 minutes. No postoperative morbidity was noted and mean cosmetic score was 9/10. The mammotome is an emerging minimal invasive tool that is safe and ensures excellent cosmesis and very high patient satisfaction rates.

Macromastia and Carpal Tunnel Syndrome: Is There an Association?

Macromastia is a disorder commonly reported by women. The prevalence of electrophysiologically confirmed, symptomatic carpal tunnel syndrome is 3% among women. A consecutive series of 31 patients with macromastia requesting breast reduction between August 2002 and April 2003 was recruited. The physical characteristics recorded included age, body mass index, and breast size. Clinical and electrophysiologic assessments of the upper limb were performed. Electrophysiologic testing showed that 7 (22%) of the 31 women had a prolonged median nerve latency conduction time longer than 0.40 ms. Age, chest circumference, and the ratio of nipple-to-inframammary line to chest circumference was associated with carpal tunnel syndrome. The prevalence of carpal tunnel syndrome among patients with macromastia was shown to be higher than in previous epidermiologic studies investigating the prevalence of carpal tunnel syndrome among women. Age, chest circumference, and breast size, but not body mass index, have a positive correlation with the increased prevalence of carpal tunnel syndrome in macromastia cases.

Reduction mammaplasty: the need for prospective randomized studies.

Reduction mammaplasty is increasingly being restricted or excluded completely by health purchasers.1 A recent example is the exclusion of breast reduction operations for obese or overweight patients on the basis of body mass index,2 even though there is evidence that this operation provides health benefits for all patients in need of the procedure, regardless of weight.3,4 In the United States, third-party insurers have declined coverage based on the amount of tissue resected. Against this background of continuing debate, there is a paucity of adequately designed studies examining the benefits of reduction mammaplasty. A review of world literature (from 1966 to 2002) using Medline/PubMed failed to show any randomized studies. Indeed, most of the available studies are retrospective, and the few prospective studies all have inherent design faults. Consequently, attempts at meta-analysis or systemic review of the literature have yielded disappointing and weak evidence.5,6 The main singular study that specifically addressed this issue in the United Kingdom had inherent problems with follow-up; whereas 166 patients began the study, only 35 percent completed the study, and this was the percentage on which inferences were drawn.7 Also, the control group used for this study was not exclusively limited to macromastia patients. Unfortunately, all the other prospective studies in the literature have also been blighted by lack of ideal control groups. The recent Breast Reduction: Assessment of Value and Outcomes (or Bravo) Study from the United States, for instance, was set up to improve the quality of evidence in the literature and concluded in favor of reduction mammaplasty. However, the control population was dissimilar from the reduction mammaplasty patients because the controls were content with their appearance physically and psychologically.8 It is significant that a majority of the studies on the outcome of reduction mammaplasty have been conducted in North America, where the cost of the operation is either reimbursed by the third-party insurance provider or paid for by patients. This has led to concerns in the literature of reporting bias by patients (exaggeration of symptoms to justify the operation) and has consequently cast doubt on the credibility of these outcome studies. This point is further illustrated by Schnur et al.,9 who comment that “most surgeons will agree that educated patients who have studied their third-party payer’s contract can develop an adequate history to show that the third-party payer should pay for the procedure.” This perhaps places the onus for more work in this field in the United Kingdom and Europe. In addition to its part in the plastic surgeon’s surgical repertoire, reduction mammaplasty is now a recognized part of the training syllabus for general surgeons with an advanced subspecialty breast interest.10 Indeed, it can facilitate the reshaping of the breast to allow breastconserving therapy for tumors that would traditionally have been treated by mastectomy.11 Thus, inability to learn these techniques on noncancer patients in the National Health Service has serious implications for the training of so-called oncoplastic breast surgeons.10 Efforts to objectively validate the medical necessity for reduction mammaplasty have been

Effects of reduction mammoplasty on upper-limb nerve conduction across the thoracic outlet in women with macromastia: a prospective randomized study.

Macromastia is a common problem. The physical complaints include upper body pain and aches. There have been anecdotal reports of neurologic deficits in the nerves emanating from the lower trunk of the brachial plexus. This is thought to be due to pressure on the lower trunk from both the first rib and tilting forward of the coracoid process. Other anecdotal reports have centered on the correction of neuropraxia of the ulnar nerve following bilateral breast reduction (BBR). We investigate the effect of BBR on the electrophysiological function of the nerve supply to the upper limbs in women with macromastia. Methodology: Consecutive patients undergoing BBR were randomized into 2 groups, depending on time of surgery. None had any prior neurologic disorder. Each patient had a comprehensive neurologic assessment and 2 electrodiagnostic neurophysiologic tests. Group 1 had 2 tests, one before surgery and a second 3 months postsurgery, while Group 2 had 2 sets of tests, one initially and a second test 4 months later (control). The outcome measures include somatosensory evoked potential (SSEP) (median and ulnar), F-wave median and ulnar latencies. The F waves measure the integrity of neural conduction time from the anterior horn cells to the hypothenar and thenar muscles reflecting lower trunk function. The SSEP of the median nerve measure the integrity of the nerve fibers traversing the upper trunk of the brachial plexus and the ulnar nerve SSEP that of the lower trunk. There was no statistical difference in the conduction times. BBR does not have any effect on the upper limb nerve conduction times.

Macromastia and carpal tunnel syndrome – Is there an association?

Macromastia is a disorder commonly reported by women. The prevalence of electrophysiologically confirmed, symptomatic carpal tunnel syndrome is 3% among women. A consecutive series of 31 patients with macromastia requesting breast reduction between August 2002 and April 2003 was recruited. The physical characteristics recorded included age, body mass index, and breast size. Clinical and electrophysiologic assessments of the upper limb were performed. Electrophysiologic testing showed that 7 (22%) of the 31 women had a prolonged median nerve latency conduction time longer than 0.40 ms. Age, chest circumference, and the ratio of nipple-to-inframammary line to chest circumference was associated with carpal tunnel syndrome. The prevalence of carpal tunnel syndrome among patients with macromastia was shown to be higher than in previous epidemiologic studies investigating the prevalence of carpal tunnel syndrome among women. Age, chest circumference, and breast size, but not body mass index, have a positive correlation with the increased prevalence of carpal tunnel syndrome in macromastia cases.