From the Department of Neurology (K.S.P., S.K., B.L.N., R.E.W.), and Department of Plastic Surgery (E.L., L.R.D., A.J.K., I.P., B.C., M.D.), Atrium Health Wake Forest Baptist; Wake Forest University School of Medicine (B.W.H., M.D.), Winston-Salem, NC; Department of Neurology (N.H.-H., J.M.P.), Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY; and Department of Neurology (L.D.S.), Virginia Commonwealth University School of Medicine, Richmond.
Neurology. 2024 Aug 13;103(3):e209660. doi: 10.1212/WNL.0000000000209660. Epub 2024 Jul 16.
Symptomatic macromastia (enlarged breasts) is a syndrome of persistent headache, neck and shoulder pain, thoracic kyphosis, painful shoulder grooving from bra straps, inframammary rash, backache, and upper extremity paresthesias. Up to 89% of the 100,000 US women undergoing breast reduction surgery (reduction mammoplasty) annually report headache preoperatively with many endorsing postoperative headache improvement. Headache is one insurance indication to cover surgical reduction, and peak prevalence of migraine matches the average age of women with macromastia at time of surgery. Little is known about the influence of macromastia on headache. The goal of our narrative review is to understand the evidence for and potential mechanisms underlying macromastia-related headache.
A literature search was performed in PubMed Medline using concepts "breast hypertrophy," "macromastia," "headache," "migraine," "breast reduction," and "reduction mammoplasty" excluding limits on age, language, publication date, or study type. Supplemental literature searches were performed to provide a comprehensive understanding of potential mechanisms underlying macromastia-related headache.
We identified 25 studies describing macromastia-associated headache in the setting of reduction mammoplasty, with 23 original research studies (retrospective, n = 12, prospective, n = 11) totaling 3,799 patients, 1 systematic review, and 1 meta-analysis. Most (24/25) were published in Plastic Surgery, one in Internal Medicine, and none in Neurology. Wide ranges were identified for preoperative headache prevalence (2%-89%) and postoperative headache improvement (34%-100%). Studies described headache as "myofascial" or "tension-type" without detailing headache definitions, chronicity, headache screening method, or neurologic examination. Potential pathophysiologic mechanisms of macromastia-associated headache include structural, mechanical, psychosocial, and hormonal.
No studies on macromastia-associated headache and reduction mammoplasty are published in Neurology. This important women's health topic remains unexplored in fields outside Plastic Surgery. Many questions remain unanswered that are important for neurologists to understand, including which headache type(s) women with macromastia experience and which headache type(s) respond to surgical intervention.
症状性巨乳症（乳房增大）是一种综合征，其特征为持续性头痛、颈肩部疼痛、胸腰椎后凸、肩带压痕疼痛、乳房下红斑、背痛和上肢感觉异常。每年有 10 万名接受乳房缩小手术（乳房缩小成形术）的美国女性中，高达 89%的女性术前有头痛，许多女性术后头痛改善。头痛是手术缩小的一个保险指征，偏头痛的高发期与乳房肥大女性接受手术的平均年龄相吻合。关于巨乳症对头痛的影响知之甚少。我们的叙述性综述的目标是了解巨乳症相关头痛的证据和潜在机制。
在 PubMed Medline 中使用“乳房肥大”、“巨乳症”、“头痛”、“偏头痛”、“乳房缩小”和“乳房缩小成形术”等概念进行文献检索，不限制年龄、语言、出版日期或研究类型。进行补充文献检索，以全面了解巨乳症相关头痛的潜在机制。
我们共确定了 25 项描述乳房缩小成形术背景下巨乳症相关头痛的研究，其中 23 项为原始研究（回顾性研究 n = 12，前瞻性研究 n = 11），共纳入 3799 例患者，1 项系统评价和 1 项荟萃分析。25 项研究中，24 项（25/25）发表于《整形外科学》，1 项发表于《内科学》，没有发表于《神经病学》的研究。术前头痛发生率（2%-89%）和术后头痛改善率（34%-100%）差异较大。研究中头痛被描述为“肌筋膜”或“紧张型”，但未详细说明头痛定义、持续性、头痛筛查方法或神经检查。巨乳症相关头痛的潜在病理生理机制包括结构、机械、心理社会和激素。
没有关于巨乳症相关头痛和乳房缩小成形术的研究发表在神经病学领域。这个重要的女性健康话题在整形外科学以外的领域仍未得到探索。许多问题仍然没有答案，这对于神经科医生来说很重要，包括巨乳症女性经历的头痛类型和哪些头痛类型可以通过手术干预得到缓解。
