breast reduction presentation
Post on 13-Aug-2015
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*Breast reduction
*Misinformation –patients motivated by cosmetic concerns, appearance
*Misperception- large breasts don’t cause significant adverse physical symptoms
*Ignorance- real motivations leading women to seek breast reduction
*Prejudice- one person’s symptoms are more deserving than another ( pain from Arthritis of the hip/knee is more valid than pain from large breasts)
*Breast reduction
*Published peer reviewed research evidence which documents the true story about women seeking breast reduction surgery
* How many breast reductions are performed in Australia?
*2013/2014
*Approx. 4000 bilateral breast reductions/year in Australia
*900 in Victoria
*Stable ( no significant increase in numbers in recent years)
*Demographics
*Age ranges from 16 to 70 years
*Major group 35-60 years
*Smaller group 25-35 years
*Vast majority of women in working years ( vast majority are actively engaged in work force at time of seeking advice)
*Motivations for surgery
*Back Pain 88%
*Neck Pain 82%
*Shoulder grooves 88%
*Rashes under breast 46%
*Headache 64%
*Exercise intolerance 80%
*Lack of self esteem 88%
*Poor posture 87%
*Motivations for surgery-My
practice
*Neck pain
*Back pain
*Shoulder pain, strap marks
*Headaches
*Poor posture
*Rashes, infections under breasts
*Inability to exercise ,exercise intolerance
*Humiliation –work, socially, buying clothes, exercising, attending commitments with children
* Does breast reduction resolve symptoms?
*Statistically significant improvement in all symptoms is seen in all patient groups
*Reproduced in multiple studies which document – symptom reduction
*Resolution of pain
* Increased exercise tolerance
*Objectively documented improved posture (small studies but xray studies show improved spinal angles)
* Improved lung function (inspiratory capacity, maximal voluntary ventilation, peak expiratory flow rate )
*Patient satisfaction
*My practice 97% satisfaction
*92-97% - symptoms completely resolved or significantly improved in multiple published research studies
*Under reported benefits
*In addition to well documented improvements in musculoskeletal pain
*Functional improvements in headaches, sleep and breathing
*Psychological benefits – significant – statistically significant improvements is self esteem, sexual function, decreased reported levels of anxiety and depression
* Types of reduction and functional gains
2 broad categories of breast reductions performed
1.Inverted T ( anchor type) scar pattern – inferior pedicle,central mound,superomedial pedicle
2. Vertical techniques (lollipop )- no inframammary scar - superior,superomedial,lateral pedicle
* Types of reduction and functional gains
*Results from both techniques equal in terms of functional outcomes
*The purported benefits of vertical techniques are “reduced scar burden”
*Only issue with this is patient do not report scar burden as a concern – both techniques have extremely high satisfaction ratings
* Types of reduction and functional gains
*Interestingly whilst there is statistical evidence the greater the weight of breast tissue reduced the greater the benefit even smaller volume reductions ( 250g /side) result in significant improvement in symptoms
* Breast feeding and Breast reduction
* What is normal?- The most recent ABS data suggests less than 40% of women who have not had a breast reduction breastfeed their babies for 3months and only 15% make it to 6months .
*The World Health Organistation recommends exclusive breast feeding for 6 months after birth (ie. only 15 % of Australian women reach that target). Australia rates well compared with other countries.
*Breast feeding after breast
reduction
*Multiple studies published looking at breast feeding after breast reduction (although small patient numbers)
*Report 60-77% of women wishing to breast feed after a variety of techniques were able to
*Only Australian data 18/19 patients were able to lactate after breast reduction
*Breast feeding after breast
reduction
*In fact one study reports in women who already had experience with breast feeding their capacity to feed increased after breast reduction
*Breast feeding after breast
reduction
*Outcomes for breast feeding after breast reduction mirror findings in the general population
*Critical elements are
*Encouragement from your doctors
*Access to quality enthusiastic support services ( lactation advisor)
* Breast cancer risk after breast reduction
It appears breast reduction significantly reduces breast cancer risk
Epidemiological study of 33,000 Scandinavian women who had breast reduction showed 28% less than expected incidence of breast cancer.
In the group of women over 50 years,43% reduced incidence of expected cases of breast cancer.
Increased breast cancer risk is absolutely not an indication for breast reduction but it is reassuring that having a reduction likely lessens your risk
* Breast imaging after breast reduction
*Issues can arise with mammographic appearances of the breast tissue after breast reduction
*All women over 40 years should have mammogram preoperatively ( pick any unsuspected issues)
*Post op mammogram as a routine 12months postop
*Conclusions
*Breast reduction is a very misunderstood and misrepresented procedure
*Patients motivations for seeking surgery are overwhelmingly physical symptoms ( pain)
*Procedure is well documented to resolve patients primary symptoms ( musculoskeletal)
*Desirable side effects – functional gains in under appreciated areas- psychosocial health, exercise tolerance , respiratory function, decreased breast cancer risk
*Does not preclude chance to breast feed
http://www.breastreductionclinic.com.au
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