The Impact of Macromastia on Adolescents: A Cross-Sectional Study

Article (PDF Available)inPEDIATRICS 130(2):e339-46 · July 2012with249 Reads
DOI: 10.1542/peds.2011-3869 · Source: PubMed
Abstract
To determine the physical and psychosocial impact of macromastia on adolescents considering reduction mammaplasty in comparison with healthy adolescents. The following surveys were administered to adolescents with macromastia and control subjects, aged 12 to 21 years: Short-Form 36v2, Rosenberg Self-Esteem Scale, Breast-Related Symptoms Questionnaire, and Eating-Attitudes Test-26 (EAT-26). Demographic variables and self-reported breast symptoms were compared between the 2 groups. Linear regression models, unadjusted and adjusted for BMI category (normal weight, overweight, obese), were fit to determine the effect of case status on survey score. Odds ratios for the risk of disordered eating behaviors (EAT-26 score ≥ 20) in cases versus controls were also determined. Ninety-six subjects with macromastia and 103 control subjects participated in this study. Age was similar between groups, but subjects with macromastia had a higher BMI (P = .02). Adolescents with macromastia had lower Short-Form 36v2 domain, Rosenberg Self-Esteem Scale, and Breast-Related Symptoms Questionnaire scores and higher EAT-26 scores compared with controls. Macromastia was also associated with a higher risk of disordered eating behaviors. In almost all cases, the impact of macromastia was independent of BMI category. Macromastia has a substantial negative impact on health-related quality of life, self-esteem, physical symptoms, and eating behaviors in adolescents with this condition. These observations were largely independent of BMI category. Health care providers should be aware of these important negative health outcomes that are associated with macromastia and consider early evaluation for adolescents with this condition.

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DOI: 10.1542/peds.2011-3869
; originally published online July 16, 2012; 2012;130;e339Pediatrics
Amy D. DiVasta, Arin K. Greene and Brian I. Labow
Felecia Cerrato, Michelle L. Webb, Heather Rosen, Laura Nuzzi, Erika R. McCarty,
The Impact of Macromastia on Adolescents: A Cross-Sectional Study
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at Vanderbilt Univ on September 25, 2012pediatrics.aappublications.orgDownloaded from
The Impact of Macromastia on Adolescents:
A Cross-Sectional Study
WHATS KNOWN ON THIS SUBJECT: Macromastia is associated
with severe physical and emotional symptoms and negatively
impacts health-related quality of life in adult women. Reduction
mammaplasty is the most effective treatment for adults. Little is
known regarding the impact of macromastia during adolescence.
WHAT THIS STUDY ADDS: Adolescents with macromastia have
impaired health-related quality of life, lower self-esteem, more breast -
related symptoms, and are at higher risk for disordered eating in
comparison with their peers. Thesenegativehealthoutcomeshave
implications for early intervention in this patient population.
abstract
OBJECTIVE: To determine the physical and psychosocial impact of
macromastia on adolescents considering reduction mammaplasty in
comparison with healthy adolescents.
METHODS: The following surveys were administered to adolescents
with macromastia and control subjects, aged 12 to 21 years: Short-
Form 36v2, Rosenberg Self-Esteem Scale, Breast-Related Symptoms
Questionnaire, and Eating-Attitudes Test-26 (EAT-2 6). Demographic
variables and self-reported breast symptoms were compared between
the 2 groups. Linear regression models, unadjusted and adjusted
for BMI categ ory (n ormal weight, overweight, obese), were tto
determine the effect of case status on survey score. Odds ratios for
the risk of disordered eating behaviors (EAT-26 score $20) in cases
versus controls were also determined.
RESULTS: Ninety-six subjects with macromastia and 103 c ontrol
subjects participated in this study. Age was similar between groups,
but subjects with macromastia had a higher BMI (P = .02). Adolescents
with macromastia had lower Short-Form 36v2 domain, Rosenberg
Self-Esteem Scale, and Breast-Related Symptoms Questionnaire scores
and higher EAT-26 scores compared with controls. Macromastia was
also associated with a higher risk of disordered eating behaviors. In
almost all cases, the impact of macromastia was independent of BMI
category.
CONCLUSIONS: Macromastia has a substantial negative impact on
health-related quality of life, self-esteem, physical symptoms, and
eating behaviors in adolescents with this condition. These observations
were largely independent of BMI category. Health care providers
should be aware of these important negative health outcomes that
are associated with macromastia and consider early evaluation for
adolescents with this condition. Pediatrics 2012;130:e339e346
AUTHORS: Felecia Cerrato, MPH,
a
,
b
Michelle L. Webb, BA,
a
,
b
Heather Rosen, MD, MPH,
a
,
b
Laura Nuzzi, BA,
a
,
b
Erika R. McCarty, BA,
a
,
b
Amy D. DiVasta, MD, MMSc,
a
,
c
Arin K. Greene, MD, MMSc,
a
,
b
and Brian I. Labow, MD
a
,
b
a
Adolescent Breast Clinic,
b
Department of Plastic and Oral
Surgery, and
c
Division of Adolescent and Young Adult Medicine,
Childrens Hospital Boston and Harvard Medical School, Boston,
Massachusetts
KEY WORDS
macromastia, adolescent, quality-of-life, self-esteem, eating
disorder, reduction mammaplasty
ABBREVIATIONS
BRSQBreast-Related Symptoms Questionnaire
EAT-26Eating Attitudes Test-26
HRQOLhealth-related quality of life
RSESRosenberg Self-Esteem Scale
ORodds ratio
SF-36Short-Form 36v2
Dr Labow is the principal investigator and Drs DiVasta and
Greene are co-investigators of this study. Drs Labow, DiVasta,
and Greene made signi cant contributions to the conception
and design, acquisition of data, interpretation of data, and
revising the article; Dr Rosen and Ms Webb made substantial
contributions to the conception and design of this study; Ms
Cerrato, Ms Webb, Ms Nuzzi, and Ms McCarty made substantial
contributions to the acquisition, analysis, and interpretation of
data; Ms Cerrato drafted the article; Drs Labow, DiVasta, and
Greene revised it for intellectual content; and all authors gave
nal approval of the version to be published. All authors have
participated sufciently in the work to take public responsibility
for appropriate portions of the content.
www.pediatrics.org/cgi/doi/10.1542/peds.2011-3869
doi:10.1542/peds.2011-3869
Accepted for publication Apr 5, 2012
Address correspondence to Brian I. Labow, MD, FACS, FAAP,
Department of Plastic and Oral Surgery, Childrens Hospital
Boston, 300 Longwood Ave, Boston, MA 02115. E-mail: brian.
labow@childrens.harvard.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2012 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no nancial relationships relevant to this article to disclose.
FUNDING: This work was supported by the Plastic Surgery
Foundation (July 2011).
PEDIATRICS Volume 130, Number 2, August 2012 e339
ARTICLE
at Vanderbilt Univ on September 25, 2012pediatrics.aappublications.orgDownloaded from
Macromastia (breast hypertrophy) is a
common condition that negatively im-
pacts the physical and mental health of
adult women who have this disorder.
114
Although macromastia often develops
during adolescence,
15
the impact of
macromastia on overall health-related
quality of life (HRQOL) in this age group
is unknown. Reduction mammaplasty,
surgical reduction of breast size, is the
most effective means of impr oving symp-
toms and HRQOL in adults.
2,4,68,13,14,1625
However, many parents and physicians
are reluctant to consider surgical cor-
rection for adolescents.
26,27
Data on the
impact of macromastia on younger pa-
tients are needed to better inform
health care providers, patients, and fam-
ilies in making appropriate treatment
decisions.
Retrospective d ata have shown that
reasons for seekin g reduction mam-
maplasty during adolescence included
pain, poor self-esteem, and difculty
nding properly tting clothes.
27
Women
who underwent r eduction mammaplasty
as adolescents reported experiencing
teasing, embarrassment, and low self-
condence preoperatively.
28
There is also evidence that younger
women (,30 years old) are troubled
by the psychosocial consequences of
macromastia, including undesired at-
tention and poor self-image.
29
Addition-
ally, eating disorders may be associated
with macromastia in young adults.
18,30
These limited retrospective studies
suggest a considerable impact of
macromastia on adolescents and imply
that early intervention may alleviate
physical and psychosocial symptoms.
However, the burden of macromastia
in a younger population has not been
measured prospectively through vali-
dated testing methodologies. We aimed
to determine the physical and psycho-
social impact of macromastia on ado-
lescent patients considering reduction
mammaplasty in comparison with a
control group.
METHODS
Subjects
Eligible subjects included adolescents
and young women between the ages of
12 and 21 years who were diagnosed
with bilateral macromastia by a plastic
surgeon and had no history of breast
surgery. Diagnosis was based on symp-
tom prole, physical examination, and
modied Shnur criteria.
31,32
Subjects
with macromastia were prospectively
enrolled at the time of initial consul-
tation t hrough the Adolescen t Breast
Clinic at the Depar tment of Plastic
and Oral Surgery at ChildrensHospi-
tal Boston from October 2008 through
August 2011.
Concurrently, female controls in the
same age range were prospectively
enrolled at clinics within the Depart-
ment of Plastic and Oral Surgery or
the Division of Adolescent/Young Adult
Medicine (a nonsurgical clinic) at the
same institution. Control subjects were
eligible if they reported a current state
of good health with no signicant past
medical or surgical history (including
diagnosis of an eating disorder or
mental health issue), no diagnosis of
a benign breast disorder, no breast
complaint, and no previous treatment
for a breast condition. Informed consent
or assent was obtained from all sub-
jects and a parent or guardian, as
applicable. This s tudy was approved by
the Childrens Hospital Boston Com-
mittee on Clinical Investigation.
Demographics and Clinical
Presentation
Height and weight were obtained on all
participants. BMI was calculated by
dividing weight (kg) by height squared
(m
2
). BMI-for-age percentiles for partic-
ipantsbetweena