Bilateral Breast Hypertrophy
Much less talked about due to unawareness and societal concerns, this condition is also referred to as Macromastia (Where excessive breast tissue is less than 2.5 kgs) or Gigantomastia (Where excessive breast tissue is more than 2.5 kgs). It occurs due to excessive enlargement of fibro fatty and glandular tissue. Normal breast shows changes from puberty onwards due to hormonal changes in the body. Lot of young girls may have excessive growth during this period, which may further increase during pregnancy and lactation. This can also associated with obesity or as a part of Polycystic Ovarian syndrome commonly called as PCO's due to associated generalized obesity.
Causes
→ Most commonly due to hormonal imbalance during pubertal and adolescence period. There is increased histological sensitivity to female hormones estrogen, progesterone and prolactin. Virginal breast hypertrophy or Gestational breast Hypertrophy
→ As a part of extreme obesity
→ It can also be associated with penicillamine therapy
Age:
Commonly seen at age from 14-18 years. Some cases are also reported between 12-14years of age or later age post pregnancy and lactation period. As an associated feature in obesity it can be seen in all ages
Progression:
Enlargement of breasts can lead to further fibrosis of glandular tissue. This may further diminish the chances of lactation post childbirth. As such there is no risk of malignance due to bilateral hypertrophy of breast, but presence of underlying cancer because of other reasons can result in late detection of cancer.
Problems related to Enlarge breast:
Physical problems:
Excessive enlargement can cause postural problems in the form of stooping. Heaviness can also cause pain in the back. Due to weight bra straps also leave marks on the shoulders. One may need to get the customized bra. Finding large bra sizes and style is challenging.
Skin rashes, fungal infections are common features as maintaining hygiene in the mammary folds is very difficult particularly in hot weather.
Societal Concerns:
Young girls and women as it is feel insecure in our society due to eve teasing, sexual abuses and Rape. With such enlarged breast young girls find it very hard to socialize. It is also difficult to hide it under normal clothing. It can lead to intense psychological problems incapacitating her in school activities and normal social relations.
Medical Management
It is not proven effective. Drugs like tamoxifen, Progesterone, Bromocryptine and testosterone have been tried. They are not indicated in virginal hypertrophy as these hormones can produce other undesirable side effects. Surgery is the only option if the decision is made for reduction in size of the breast.
Surgical Procedures
Presently, Vaser liposuction alone has been tried with good success. But it can be used to reduce only small quantities of breast size. For excessive sizes and extra skin Reduction mammoplasty is the best surgical choice.
Indication for Surgery:
→ Breasts that are too large in proportion to your body frame.
→ Heavy, pendulous breasts with nipples and areolas that point downward.
→ One breast is much larger than the other.
→ Back, neck or shoulder pain caused by the weight of your breasts.
→ Skin irritation in the fold of the breasts.
→ Indentations on the shoulders from tight bra straps.
→ Restriction of physical activity due to the size and weight of breasts.
→ Dissatisfaction or self-consciousness about the largeness of your breasts.
Various techniques have been described to make the breast size smaller. This is the condition where it is commonly perceived as small is more. Depending upon the breast size and the Surgeon's experience the technique is decided upon. After removal of excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.
Usually, the nipples and areolas remain attached to underlying mounds of tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed. Skin that formerly was located above the nipple is brought down and together to reshape the breast.
Rarely, if the breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, decision will have to be made to sacrifice sensation and the possibility of breast-feeding in order to achieve the desired breast size.
Note:
Cost includes the surgical fee and day care hospital cost or one day hospital cost in a single room as applicable to a surgery. If for some reason you need/want to stay in hospital for additional time, you will have to pay that separately. Cost will also increase if you choose a superior room.
Cost mentioned or discussed is approximations only, for general guidance. They are subject to change. Prices apply to average healthy individuals. If you have additional problems like diabetes/ hypertension etc, which require the involvement of another specialist/ special medications/ anaesthesia, such cost will be added.
FAQ
What is the right age for breast reduction surgery?
Breast reduction can be performed at any age, but it is recommended to wait until breast development has stopped, usually by 18 years. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women have breast reduction done even in their teens if the symptoms are severe and causing health, social and psychological problems.
How is breast reduction performed?
Individual factors and surgeon's preferences will determine the specific technique selected to reduce the size of your breasts. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. After the excess breast tissue, fat and skin are removed; the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm. Usually, the nipples and areolas remain attached to remaining breast tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed.
What are the risks involved with breast reduction surgery?
Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revision surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.
How soon can I recover following my surgery?
The day after surgery, you will be encouraged to get out of bed for short periods of time. Within a week you will be able to your routine work. Strenuous activities can be generally allowed after 6-8 weeks of surgery . Any sexual activity should be avoided for a minimum of one week depending upon your healing you may be advised to wait longer.
Will the scars be visible?
There will be a scar around your nipple-areolar complex and a vertical scar running down. These scars will heal fade over time. Normally they become inconspicuous over a period of time also they are concealed by the breast tissue itself.
Will my breasts grow big again?
If you are planning pregnancy and feeding, the breast size may increase as it routinely does. Unless you significantly gain weight or become pregnant, your breast size should remain fairly constant.
How long do I need to see the doctor after surgery?
You will return to the clinic for follow-up care at prescribed intervals, usually 2 days, 2 weeks one month and 3 months later. At these visits your progress will be evaluated and minor problems are taken care of. Once the immediate postoperative follow-up is complete you come back for periodic checkups to observe and discuss the long-term results of surgery.
Will I be able to breast feed after breast reduction surgery?
Due to original condition itself your chances of breast-feeding are not assured. Your chances of breast-feeding may remain same or reduce after breast reduction surgery. A lot of women have breastfed after this surgery but there is no guarantee that you will be able to do so.
Are there methods available to reduce the scarring?
Creams, gels and taping for 3-6 months, can improve scars. Excessively prominent scars can be revised surgically after 6 months.
Is there a way to do breast reduction surgery without scars?
Liposuction surgery can remove fat but not the gland part so breasts can be reduced to some extent by liposuction through small holes but big reduction is not possible by this method. Breasts also will sag after liposuction.
Is there a risk of breast cancer in future after breast reduction?
Breast reduction surgery does not increase your risk of developing breast cancer. Depending on your age, or if you have a history of breast cancer in your family, you may be required to get baseline mammogram before surgery.
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