Editing Breast reduction (section)

==Presentation==
The patient with [[Breast hypertrophy|macromastia]] presents heavy, enlarged breasts that sag and cause chronic pains to the head, neck, shoulders, and back; an oversized [[Cleavage (breasts)|bust]] also causes secondary health problems, such as poor [[Circulatory system|blood circulation]], impaired [[breathing]] (inability to fill the lungs with air); chafing of the skin of the chest and the lower breast (inframammary intertrigo); brassière-strap indentations to the shoulders; and the improper fit of clothes.

In the patient affected by [[Breast hypertrophy|gigantomastia]] (>1,000 gm overweight per breast), the average breast-volume reduction diminished the oversized bust by three brassière cup-sizes.<ref>{{cite journal |last1=Heine |first1=N. |last2=Eisenmann-Klein |first2=M. |last3=Prantl |first3=L. |title=Gigantomasty: Treatment with a Short Vertical Scar |journal=Aesthetic Plastic Surgery |volume=32 |issue=1 |pages=41–7 |year=2008 |pmid=17874160 |doi=10.1007/s00266-007-9005-x |s2cid=7619958 }}</ref> The surgical reduction of abnormally enlarged breasts resolves the physical symptoms and the functional limitations imposed by a bodily disproportionate bust; thereby, it improves a patient's physical and [[mental health]].<ref>{{cite journal |last1=O'Blenes |first1=Catherine A. E. |last2=Delbridge |first2=Catherine L. |last3=Miller |first3=Brian J. |last4=Pantelis |first4=Andreou |last5=Morris |first5=Steven F. |title=Prospective Study of Outcomes after Reduction Mammaplasty: Long-Term Follow-Up |journal=Plastic and Reconstructive Surgery |volume=117 |issue=2 |pages=351–8 |year=2006 |pmid=16462312 |doi=10.1097/01.prs.0000201493.76256.65 |s2cid=23076753 }}</ref><ref>{{cite journal |last1=Miller |first1=Brian J. |last2=Morris |first2=Steven F. |last3=Sigurdson |first3=Leif L. |last4=Bendor-Samuel |first4=Richard L. |last5=Brennan |first5=Mike |last6=Davis |first6=George |last7=Paletz |first7=Justin L. |title=Prospective Study of Outcomes after Reduction Mammaplasty |journal=Plastic and Reconstructive Surgery |volume=115 |issue=4 |pages=1025–31; discussion 1032–3 |year=2005 |pmid=15793440 |doi=10.1097/01.PRS.0000154212.10845.54 |s2cid=45918566 }}</ref><ref>{{cite journal |last1=Mello |first1=Arnaldo A. |last2=Domingos |first2=Neide A. M. |last3=Miyazaki |first3=M. Cristina |title=Improvement in Quality of Life and Self-Esteem After Breast Reduction Surgery |journal=Aesthetic Plastic Surgery |volume=34 |issue=1 |pages=59–64 |year=2010 |pmid=19768493 |doi=10.1007/s00266-009-9409-x |s2cid=1523213 }}</ref><ref>{{Cite web |last=Manis |first=Emily |date=2023-05-16 |title=Women who have larger breasts tend to have lower levels of satisfaction with their breasts, study finds |url=https://www.psypost.org/2023/05/women-who-have-larger-breasts-tend-to-have-lower-levels-of-satisfaction-with-their-breasts-study-finds-163175 |access-date=2023-12-24 |website=PsyPost |language=en-US}}</ref><ref>{{cite journal |last1=Cherchel |first1=A. |last2=Azzam |first2=C. |last3=De Mey |first3=A. |title=Breastfeeding after vertical reduction mammaplasty using a superior pedicle |journal=Journal of Plastic, Reconstructive & Aesthetic Surgery |volume=60 |issue=5 |pages=465–70 |year=2007 |pmid=17399654 |doi=10.1016/j.bjps.2006.05.023 }}</ref> Afterwards, the patient's ability to comfortably perform physical activities previously impeded by oversized breasts improves emotional health ([[self-esteem]]) by reducing [[anxiety]] and lessening [[Depression (mood)|psychological depression]].<ref>{{cite journal |last1=Iwuagwu |first1=OC |last2=Stanley |first2=PW |last3=Platt |first3=AJ |last4=Drew |first4=PJ |last5=Walker |first5=LG |title=Effects of bilateral breast reduction on anxiety and depression: Results of a prospective randomised trial |journal=Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery |volume=40 |issue=1 |pages=19–23 |year=2006 |pmid=16428209 |doi=10.1080/02844310500415335 |s2cid=35137225 }}</ref>

===Medical history===
The medical history records the patient's age, the number of children the patient has borne, the patient's [[Breastfeeding|breast-feeding]] practices, plans for pregnancy and nursing of the infant, medication allergies, and tendency to bleeding. Additional to the personal medical information are the patient's history of [[tobacco smoking]] and concomitant diseases, breast-surgery and breast-disease histories, family history of [[breast cancer]], and complaints of neck, back, shoulder pain, breast sensitivity, rashes, infection, and upper extremity numbness.{{citation needed|date=July 2015}}

The physical examination records and establishes the accurate measures of the patient's [[body mass index]], vital signs, the mass of each breast, the degree of inframammary intertrigo present, the degree of [[Ptosis (breasts)|breast ptosis]], the degree of enlargement of each breast, lesions to the skin envelope, the degree of sensation in the [[Areola|nipple–areola complex]] (NAC), and discharges from the nipple. Also noted are the secondary effects of the enlarged breasts, such as shoulder-notching by the brassière strap from the breast weight, [[kyphosis]] (excessive, backwards curvature of the [[Thoracic vertebrae|thoracic region]] of the [[spinal column]]), skin irritation, and skin rash affecting the breast crease (IMF).<ref name="EspinosadelosMonteros">{{EMedicine|article|1274770|Lejour Breast Reduction}}</ref>

===Cause===
Large breasts are usually developed during [[thelarche]] (the pubertal breast-development stage), but they can also develop postpartum, after gaining weight, at [[menopause]], and at any age. Macromastia usually develops in consequence to the [[hypertrophy]] (overdevelopment) of [[Adipose tissue|adipose fat]], rather than to milk-gland hypertrophy. Moreover, many are [[Genetics|genetically]] predisposed to developing large breasts, the size and weight of which are often increased, either by [[pregnancy]], by weight gain, or by both conditions; there also exist [[Iatrogenesis|iatrogenic]] (physician-caused) conditions such as post–[[mastectomy]] and post–[[lumpectomy]] asymmetry. Nonetheless, it is statistically rare for a young person to experience juvenile mammary hypertrophy that results in massive, oversized breasts, and recurrent [[Hypertrophy of breast|breast hypertrophy]].{{citation needed|date=July 2015}}

The abnormal enlargement of the breast tissues to a volume in excess of the normal bust-to-body proportions can be caused either by the overdevelopment of the [[Lactiferous duct|milk glands]] or of the [[adipose tissue]], or by a combination of both occurrences of hypertrophy. The resultant breast-volume increases can range from the mild (<300 gm) to the moderate (ca. 300–800 gm) to the severe (>800 gm). Macromastia can be manifested either as a unilateral condition or as a bilateral condition (single-breasted enlargement or double-breasted enlargement) that can occur in combination with sagging, [[Ptosis (breasts)|breast ptosis]] that is determined by the degree to which the nipple has descended below the inframammary fold (IMF).<ref name="Grippaudo">{{EMedicine|article|1276259|Liposuction Only Breast Reduction}}</ref>

===Therapeutic approaches===

====Medical====
Breast hypertrophy (macromastia and gigantomastia) does not respond to medical therapy, but a weight-reduction regimen for the certain patients can alleviate some of the excessive size and volume of abnormally enlarged breasts.<ref name=pmid15759094>{{cite journal |last1=Sadove |first1=Richard |title=New Observations in Liposuction-Only Breast Reduction |journal=Aesthetic Plastic Surgery |volume=29 |issue=1 |pages=28–31 |year=2005 |pmid=15759094 |doi=10.1007/s00266-004-0029-1 |s2cid=10254920 }}</ref> Physical therapy provides some relief for neck, back, or shoulder pain. Skin care will diminish breast crease inflammation and lessen the symptoms caused by moisture, such as irritation, chafing, infection, and bleeding.{{citation needed|date=October 2015}}

====Surgical====
The traditional surgical techniques for breast reduction remodel the breast mound using a skin and glandular (breast tissue) pedicle (inferior, superior, central), and then trim and re-drape the skin envelope into a new breast of natural size, shape, and contour; it produces long surgical scars upon the breast hemisphere. In response, L. Benelli, in 1990, presented the round block mammoplasty, a minimal-scar periareolar incision technique that produces only a periareolar scar – around the NAC, where the dark-to-light skin-color transition hides the surgical scar.<ref>{{cite journal |last1=Benelli |first1=Louis |title=A new periareolar mammaplasty: The 'round block' technique |journal=Aesthetic Plastic Surgery |volume=14 |issue=2 |pages=93–100 |year=1990 |pmid=2185619 |doi=10.1007/BF01578332 |s2cid=35418572 }}</ref>