Macromastia is the increase in the size of the breast in a woman, in terms of volume and weight, to the extent that it causes concrete complaints such as pain and skin changes, etc., in addition to visual dissatisfaction. Apart from aesthetic concerns regarding body appearance, it can also cause many complaints. For example, among these complaints, the best described are backache, lower back pain, some breathing problems, color changes on the skin, and the fact that the underwear used leaves a mark on the shoulder and causes deformity in the subcutaneous fat tissue.
Causes and formation.
Normal breast development begins with the formation of the milk line in the 20th week of pregnancy. During the period until birth, fatty tissue-connective tissue, mammary glands and milk ducts, which are the components of the breast tissue, are formed. These structures in rough form complete their development in a process that will continue for 3 to 5 years under the influence of sex hormones (estrogen, progesterone, testosterone) and growth hormones during puberty.
As it is known, breast tissue is a It has a secretory activity component and a fat and connective tissue component, which we call support tissues. The hormonal factors affecting both components may differ from each other. While the mammary glands and milk ducts are affected by estrogen-progestreon-prolactin hormones, especially the fat and connective tissue component of the breast is affected by growth hormone.
However, it is difficult to say the exact cause of macromastia. Pregnancy and weight gain are considered major stimulating factors. However, body asymmetry that occurs in some patients who have undergone breast surgery is also considered to be another factor.
Macromastia (excessive breast enlargement), which may rarely occur during adolescence due to the effect of sex hormones and growth hormone, may cause the person to undergo "repeated breast reduction" surgeries. may also cause it to enter. However, macromastia seen with pregnancy can regress considerably after pregnancy and breastfeeding.
Clinical symptoms
Macromastia brings with it various physical and psychosocial problems. Pain in the breast due to excessive growth, shoulder pain, tension in the breast skin, and color changes in the shoulder skin due to bra compression may occur. With this Posture disorders may result in neck, back and waist pain. Sometimes this condition can even affect physical activity and sleep quality. In some advanced cases, excessive sweating under the breast may also cause hygienic problems.
Psychosocial problems mostly appear as body perception and self-confidence problems, and if the person is not well informed during adolescence, it may cause loss of self-confidence and social phobias.
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Who should be treated?
Very careful attention should be paid to patient selection. Although patients with musculoskeletal system complaints such as back-waist-shoulder pain etc. are considered candidates in the literature, the main thing to be careful about here is the person's body mass index. It should be clearly stated here that, as a general rule, patients undergoing breast reduction surgery should not be 20% over their ideal weight. In cases where medical necessity prevails over aesthetic concerns, it is a generally accepted rule today that the minimum weight of breast tissue removed for reduction purposes is 500 grams.
Although there is no absolute contraindication in breast reduction surgeries, this surgery is suitable for diabetic patients. It should not be applied to people with chronic lung disease and kidney failure. Chronic smoking and advanced age are situations that require careful decision-making. However, in cases where breast development is not completed and in those who have never given birth, the decision for surgery should be made in a multidisciplinary manner and the necessity of the surgery should be carefully evaluated.
Before the surgery, the breast should be carefully evaluated whether there is a precancerous disease 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 thoroughly informed about this.
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