From the Department of Pediatrics and the Division of Plastic and Reconstructive Surgery, University of Alberta.
Plast Reconstr Surg. 2021 Jul 1;148(1):31-43. doi: 10.1097/PRS.0000000000008102.
Reduction mammaplasty for macromastia is one of the most common operations performed by plastic surgeons. There remains hesitancy in operating on adolescents, as there is ongoing debate about breast regrowth and potential impact on breastfeeding. The goal of this study was to analyze these concerns by reviewing the current literature.
A systematic review of MEDLINE, Scopus, and Google Scholar was conducted using the following terms: "breast reduction" or "mammaplasty" or "breast reconstruction" and "adolescent" or "youth" or "pediatric" or "child" or "teen." Primary outcomes were success of breastfeeding after the procedure and procedure-related complications.
Twenty-three studies (87 percent retrospective), consisting of 2926 patients with preoperative cup sizes of C to KK (mean, DDD), met inclusion criteria. Mean age at the time of surgery ranged from 16 to 21 years, with the youngest patient being 12 years old. The overall complication rate was 27.3 percent (95 percent CI, 14.4 to 42.5 percent). Minor complications (22.8 percent; 95 percent CI, 10.2 to 38.5 percent) were more common than major (4.2 percent; 95 percent CI, 1.6 to 7.9 percent). Eighteen percent of patients (95 percent CI, 2.2 to 43.8 percent) reported regrowth of their breast tissue postoperatively, with 2.7 percent (95 percent CI, 0.9 to 5.5 percent) undergoing a second revision mammaplasty. Fifty-three percent of patients (95 percent CI, 36.0 to 69.3 percent) did not attempt breastfeeding. Of those who attempted, 55.1 percent (95 percent CI, 34.4 to 74.9 percent) were successful.
Prospective data are lacking. Patient counseling should focus on encouraging a trial of breastfeeding, despite surgical history. One-fifth of adolescent patients may notice breast regrowth postoperatively; however, the amount of regrowth is likely small and unlikely to reexacerbate symptoms, as the rate of revision surgery is small.
巨乳缩小术是整形外科医生最常进行的手术之一。对于青少年患者，医生仍持犹豫态度，因为目前对于乳房的再次发育以及对母乳喂养的潜在影响仍存在争议。本研究旨在通过回顾现有文献来分析这些顾虑。
使用以下术语对 MEDLINE、Scopus 和 Google Scholar 进行系统回顾：“乳房缩小术”或“乳房成形术”或“乳房重建”和“青少年”或“青年”或“儿科”或“儿童”或“青少年”。主要结果是术后母乳喂养的成功率和与手术相关的并发症。
共有 23 项研究（87%为回顾性研究）符合纳入标准，共纳入 2926 例术前杯罩尺寸为 C 至 KK（平均为 DDD）的患者。手术时的平均年龄为 16 至 21 岁，最小的患者为 12 岁。总体并发症发生率为 27.3%（95%置信区间，14.4%至 42.5%）。轻度并发症（22.8%；95%置信区间，10.2%至 38.5%）比重度并发症（4.2%；95%置信区间，1.6%至 7.9%）更常见。18%的患者（95%置信区间，2.2%至 43.8%）报告术后乳房组织有再生，其中 2.7%（95%置信区间，0.9%至 5.5%）需要进行第二次乳房成形术修正。53%的患者（95%置信区间，36.0%至 69.3%）未尝试母乳喂养。在尝试母乳喂养的患者中，55.1%（95%置信区间，34.4%至 74.9%）成功。
目前缺乏前瞻性数据。患者咨询应侧重于鼓励尝试母乳喂养，尽管有手术史。五分之一的青少年患者术后可能会注意到乳房再生；然而，再生的量可能很小，不太可能再次加重症状，因为修正手术的比例很小。
