Osler Medical Residency, Johns Hopkins Hospital, Baltimore, MD, United States.
Emory University School of Medicine, Atlanta, GA, United States.
J Plast Reconstr Aesthet Surg. 2023 Feb;77:209-217. doi: 10.1016/j.bjps.2022.12.003. Epub 2022 Dec 19.
Macromastia in adolescents is both physically and psychologically debilitating during a period in life when individuals are particularly vulnerable to peer pressure and social norms. Early recognition and intervention by both pediatricians and surgeons are critical to avoid unnecessary suffering. While reduction mammaplasty is the gold standard for the management of symptomatic macromastia in adults, the management of macromastia in pediatric patients remains controversial. In particular, there is great discussion regarding the timing of reconstructive breast surgery in pediatric patients.
A comprehensive review of the literature was performed to identify all articles related to macromastia in patients ≤16 years of age, the age at which full development is typically achieved in the United States. The etiologies of pediatric macromastia, approaches to management, and outcomes are summarized herein.
Pathological breast hypertrophy in pediatric patients is a rare finding and may occur secondary to juvenile hypertrophy of the breast (JHB) and pseudoangiomatous stromal hyperplasia (PASH). While medical management of these pathologies has been attempted with varying success, reduction mammaplasty is safe and effective in pediatric patients. There are, however, a number of pediatric-specific considerations that must be taken into account prior to surgery. We provide an algorithm for approaching pediatric macromastia.
青少年巨乳症在人生中特别容易受到同伴压力和社会规范影响的时期，不仅会给身体带来负担，还会给心理带来负担。儿科医生和外科医生的早期识别和干预对于避免不必要的痛苦至关重要。虽然缩乳术是治疗成人症状性巨乳症的金标准，但儿科患者巨乳症的管理仍存在争议。特别是，对于儿科患者重建性乳房手术的时机存在很大的讨论。
对所有与≤16 岁患者巨乳症相关的文献进行了全面回顾，这个年龄在美国通常是乳房完全发育的年龄。本文总结了儿科巨乳症的病因、治疗方法和治疗效果。
儿科患者的病理性乳房肥大是一种罕见的发现，可能继发于青少年乳房肥大（juvenile hypertrophy of the breast，JHB）和假性血管瘤样间质增生（pseudoangiomatous stromal hyperplasia，PASH）。虽然这些病变已经尝试了药物治疗，但缩乳术在儿科患者中是安全有效的。然而，在手术前还需要考虑许多儿科特有的问题。我们提供了一种处理儿科巨乳症的算法。
