What is adolescent macromastia?

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What is adolescent macromastia?

Adolescent macromastia is the continuous overgrowth of breast tissue that begins and continues throughout puberty. Although there are several theories as to what causes this condition, there is insufficient data to identify a singular cause.

What are the signs and symptoms of macromastia?

Physical signs and symptoms of macromastia include:

Shoulder grooving from bra straps
Pain in the shoulders, neck and back
Skin changes under the breast (intertrigo)
Decreased ability to perform physical activities due to breast pain
Chronic headaches/migraines
Macromastia may also present with several psychological symptoms including:

Poor self-esteem
Social embarrassment
Anxiety
Depression
Eating disorders
Psychosexual dysfunction
What is the recommended treatment for macromastia?

The most accepted first line of treatment for macromastia is breast reduction surgery. This operation is the ideal treatment method for improving health-related quality of life and resolving preoperative symptoms. Other medical treatment options, such as hormone-modulators, do exist; however, these medications have varying results because they simply stop breast growth without alleviating symptoms.

When should patients seek surgical consultation?

Timing of breast reduction surgery in adolescent girls with macromastia can be challenging due to the concern for recurrence after surgery. This operation is currently recommended in girls who have had one year of breast growth stabilization, which commonly occurs between the ages of 16-18. Other factors we consider when determining optimal surgical timing include the following: psychological stability, stable weight with healthy body mass index (BMI), maturity of patient and family support.  

What can patients expect at their preoperative visit?

Here at Texas Children’s Hospital, the Plastic Surgery Department uses shared medical appointments for patients with adolescent macromastia seeking breast reduction surgery. These structured clinical visits include a shared educational presentation, a group question-answer session and a private surgical consultation. The shared presentation and group discussion allow patients and families to learn more about macromastia and also hear responses to questions they may not have thought to ask during their appointment. Afterward, patients have a private consultation which includes meeting with all medical disciplines that aid in the care of macromastic patients. These include: a plastic surgeon, psychologist, physical therapist and nutritionist.

Will insurance cover a breast reduction surgery for adolescents with macromastia?

Breast reduction surgery is covered by many insurance carriers. However, most insurance companies require documentation of the following:

Neck/shoulder/back pain not alleviated by physical therapy
Shoulder grooving from bra straps
Skin changes under the breast (intertrigo)
Failure of alternate therapies, such as physical therapy, weight loss and pain medication
These obstacles may delay care and worsen the psychological and physical impact on girls with macromastia, which is why we aim to address these barriers early.

What are the benefits of having a breast reduction?

Adolescents with macromastia who undergo breast reduction surgery are exchanging debilitating symptoms for an improved quality of life with scars.  This operation has shown excellent long-term results including:

Alleviation of pain in the back, neck and shoulders
Better posture and upper body strength
Improved exercise tolerance
Decreased sleep disturbances
Improved self-esteem
Decreased anxiety and depression
Weight loss

Post by: Jill Schulten, M.Ed., MCMSc,ATC, PA-C

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