Risk Factors for Severe Macromastia in Adolescents
Gabrielle G. Massey; Laura C. Nuzzi, BA; Catherine McNamara, BS; Joseph M. Firriolo, MD; John G. Meara, MD, DMD, MBA; Brian I. Labow, MD Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Background:
There is an increasing incidence of adolescents undergoing reduction mammaplasty. However, the etiology of adolescent macromastia (breast hypertrophy) is poorly understood. This study is the first of its kind to explore the association between potential risk factors and macromastia severity using a robust sample size.
Methods:
Symptomology and medical history were collected using standardized clinical forms from patients between the ages of 12-21 years undergoing bilateral reduction mammaplasty. To account for differences in body habitus, macromastia severity was determined by dividing the amount of breast tissue resected for each patient by their body surface area.
Results:
A total of 357 subjects were included, with median surgical age of 17.9 (IQR: 2.5) years. The following factors were associated with having significantly worse macromastia: hormonal dysregulation, racial minority status, overweight or obesity status, and precocious menarche (p < 0.05, all). In particular, girls who were overweight or obese, or experienced precocious menarche were three to four times more likely to have severe breast hypertrophy. Conversely, precocious thelarche and having a first-degree relative with macromastia or breast cancer did not increase patients’ odds of having increased hypertrophy (p > 0.05, all).
Conclusion:
Adolescent girls with macromastia who experienced hormonal dysregulation, are racial minorities, are overweight or obese, or had precocious menarche are at greater risk for developing more severe breast hypertrophy. Healthcare providers should screen for these risk-factors in their adolescent macromastia patients and make early referral to a surgeon for treatment when appropriate.
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