WHAT DOES MACROMASTIA (LARGE BREAST) MEAN? HOW IS THE TREATMENT AND WHAT SHOULD BE CONSIDERED?

Macromastia is the increase in the size of the breast in a woman in terms of volume and weight, causing concrete complaints such as pain and skin changes, as well as visual dissatisfaction. Body appearance Apart from aesthetic concerns, it can also cause many complaints. For example, it is used for back pain, low back pain, some respiratory problems and skin color changes. It is best defined that the work leaves a scar on the shoulder and causes deformity in the subcutaneous adipose tissue. 

Causes and occurrence

Normal breast development begins with the formation of the milk line at the 20th week of pregnancy. During the period until birth, adipose tissue-connective tissue, which are components of breast tissue, and milk glands and milk ducts occur. These structures in draft form complete their development in a period of 3 to 5 years with the effect of sex hormones (strogen, progesterone, testosterone) and growth hormones (growth hormone) together with puberty.   

As is known, the breast tissue has a component that performs a secretory activity, and there is a component of adipose and connective tissue, which we call support tissues. Hormonal factors affecting both components can be different from each other. While the mammary glands and milk ducts are affected by the hormones strogen-progestreon-prolactin,  Especially the fat and connective tissue component of the breast is affected by the growth hormone.

However, it is difficult to say the exact cause of macromastia. Pregnancy and weight gain are considered to be major stimulant factors. However, the body asymmetry that occurs in some patients who have undergone breast surgery is also considered as another factor.

Macromastia (excessive breast enlargement), which may occur rarely in adolescence with the effect of sex hormones and growth hormone, is a person's “reductive breast reduction” It can also lead to surgery. However, macromastia seen with pregnancy can regress considerably after pregnancy and breastfeeding.

Clinical manifestations  

Macromastia brings with it various physical and psychosocial problems. There may be pain in the breast due to excessive growth, shoulder pain, tightness in the breast skin, and color changes in the shoulder skin due to the pressure of the bra. However, there may be posture disorders and related neck-back-low back pain. Sometimes this can even affect physical activity and sleep quality. In some advanced cases, excessive sweating under the breast can also bring along hygienic problems.

Psychosocial problems appear mostly as body image and self-confidence problems, and if the person is not well informed during the adolescence period, it can cause loss of confidence and social phobias.  

 To whom should it be done?

It is necessary to be very careful in patient selection.  Although patients with musculoskeletal complaints such as back-waist-shoulder pain etc. are considered as candidates in the literature, the body mass index of the person is one of the most important issues to be considered here. Here, as a general rule, it should be clearly stated that the ideal weight of the patients who will undergo breast reduction surgery should not be above 20%. It is a generally accepted rule today that the minimum weight of the breast tissue removed for reduction is 500 g, in cases where the medical necessity outweighs the aesthetic concerns.

Although there is no absolute contraindication in breast augmentation surgeries, this surgery should not be performed in diabetic patients, people with chronic lung disease and people with kidney failure. Chronic smoking and advanced age are conditions that require careful decision-making. However, in cases where breast development is not completed, it is not at all; In those who have not given birth, the decision of surgery should be made multidisciplinary and the necessity of the surgery should be well evaluated.

Before the operation, it should be carefully evaluated whether there is a precancerous disease in the breast with a good physical examination and imaging. It should be revealed in detail which risk factors the patient has for breast cancer, and the patient should be well informed about this.