Effect of reduction mammoplasty on chest wall compliance

Abstract

Sir, Macromastia can be a debilitating condition, which affects patients both physically and psychologically. Patients have reported significant improvement in respiratory and chronic pain symptoms following reduction mammoplasty (RM). Yet, there is an ongoing debate whether surgical intervention is for functional or cosmetic reasons. Studies have demonstrated a trend towards an improvement in pulmonary function (PF) following RM, but none have directly measured chest wall compliance (CWC) [1, 2]. We present evidence of immediate improvements in CWC in a patient with bilateral breast hypertrophy undergoing RM. A 35-year-old G3P3A0, nonsmoking, otherwise healthy female presented for consultation for bilateral breast reduction. Upon questioning, it was noted that she was complaining of persistent orthopnea at rest upon lying supine. This was significantly improved upon inclining her sleeping position. Upon examination, it was noted that her sternal– nipple distance were 58 and 56 cm on left and right, respectively, with bilateral grade III ptosis. Preoperative consultation with respirology was subsequently done to rule out any other possible etiologies for persistent orthopnea. The results did not demonstrate any obstructive lung disease. However, there was a reduced functional residual capacity (FRC) and expiratory reserve volume (ERV). Patient underwent bilateral breast reduction using invertedT mammaplasty with “Thorek” nipple–areola complex graft with no complications. Total reduction weights were 4.9 and 4.2 kg for left and right breast, respectively. Intraoperative compliance studies were done, while she was under anesthesia and paralyzed, which demonstrated an improvement of 35.2 to 37.8 mL/cm H2O (Table 1). Her postoperative course was uncomplicated. At 12 months postoperatively, she reported resolution of her orthopnea and substantial improvement in her mood. Additionally, subsequent PF testing revealed an increase by 8.93 and 13.3 % in total lung capacity (TLC) and ERV, respectively. FRC improved from 71.4 % of predicted preoperative to 75.1 % of predicted on 12-month follow-up postreduction. RM remains as one of the most commonly requested reconstructive procedures due to the debilitating symptoms of hypertrophic breasts. However, many in both the medical community and third party payers continue to classify RMs as a cosmetic procedure. It has been reported that there is no correlation between clinical evidence and eligibility criteria set by insurance companies [3]. Our patient, with no known history for heart disease, presented with chronic pain in her shoulder, back, neck, and breasts and a persistent orthopnea exacerbated when lying supine. Following a RM with a total resection of 9.1 kg bilaterally, she reported immediate postoperative symptomatic relief. In addition to the abundance of subjective gains reported by patients, RMs benefit the health and well-being of its recipients. Our patient reported an increase in her level of activity and comfort. Chest loading in healthy nonobese patients leads to decreased lung volumes and increases in Ali Izadpanah and Mihiran Karunanayake contributed equally to this work.