From the Adolescent Breast Clinic, the Department of Plastic and Oral Surgery, and the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Harvard Medical School.
Plast Reconstr Surg. 2019 Sep;144(3):572-581. doi: 10.1097/PRS.0000000000005907.
Adolescent reduction mammaplasty remains controversial because of concerns of postoperative breast growth, complications, and the effect on well-being. The authors sought to prospectively quantify early and late complications following reduction mammaplasty in adolescents and young women, and examine the intersection of surgical complications and postoperative health-related quality of life.
From 2008 to 2017, female patients aged 12 to 21 years undergoing reduction mammaplasty were asked to complete the 36-Item Short-Form Health Survey (version 2), the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, and the Eating-Attitudes Test-26 preoperatively and postoperatively at 6 months and 1, 3, 5, and 7 years. Clinical evaluations using standardized forms assessed baseline and postoperative symptomatology, complications, and surgical outcomes.
In the authors' sample of 512 participants, the most common complications included hypertrophic scarring (20.0 percent) and altered sensation of the nipple (8.4 percent) or breast (7.8 percent). Patient age, body mass index category, and amount of tissue resected did not significantly increase the odds of developing a complication. Significant postoperative improvements on the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, the Eating-Attitudes Test-26, and in all 36-Item Short-Form Health Survey domains (i.e., physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) were largely seen irrespective of whether complications occurred.
Although complications following reduction mammaplasty were common, the vast majority were minor. Patients had significant postoperative improvements in their physical and psychosocial well-being regardless of whether they experienced a complication. Concerns for potential complication, especially in younger and overweight or obese patients, should not preclude otherwise healthy adolescents and young women from the benefits of reduction mammaplasty.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
由于担心术后乳房发育、并发症以及对健康的影响，青少年乳房缩小术仍然存在争议。作者旨在前瞻性地量化青少年和年轻女性乳房缩小术后的早期和晚期并发症，并研究手术并发症与术后健康相关生活质量的交叉点。
2008 年至 2017 年，接受乳房缩小术的 12 至 21 岁女性患者被要求在术前和术后 6 个月、1 年、3 年、5 年和 7 年完成 36 项简短健康调查问卷（第 2 版）、罗森伯格自尊量表、乳房相关症状问卷和饮食态度测试-26。使用标准化表格进行临床评估，评估基线和术后症状、并发症和手术结果。
在作者的 512 名参与者样本中，最常见的并发症包括肥厚性瘢痕（20.0%）和乳头（8.4%）或乳房（7.8%）感觉改变。患者年龄、体重指数类别和切除的组织量并没有显著增加发生并发症的几率。在罗森伯格自尊量表、乳房相关症状问卷、饮食态度测试-26 以及所有 36 项简短健康调查问卷领域（即身体功能、角色身体、身体疼痛、一般健康、活力、社会功能、角色情感和心理健康）上，术后显著改善，尽管发生了并发症，但绝大多数仍有显著改善。
尽管乳房缩小术后的并发症很常见，但绝大多数都是轻微的。患者的身体和心理社会健康在术后都有显著改善，无论他们是否经历了并发症。对潜在并发症的担忧，尤其是在年轻、超重或肥胖患者中，不应阻止其他健康的青少年和年轻女性从乳房缩小术获益。
临床问题/证据水平：治疗，IV。
