Practice 10-Minute Consultation

Macromastia (large breasts): request for breast reduction

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5408 (Published 13 October 2010) Cite this as: BMJ 2010;341:c5408
  1. K Shokrollahi, specialist registrar in plastic surgery1,
  2. I S Whitaker, specialist registrar in plastic surgery1,
  3. S R Manning, clinical education fellow2,
  4. D Mannasiev, general practitioner3,
  5. L Y Hiew, consultant plastic surgeon1,
  6. M A C S Cooper, consultant plastic surgeon1
  1. 1The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Morriston, Swansea, UK
  2. 2Sandwell District General Hospital, Lyndon, West Bromwich, West Midlands, UK
  3. 3Goodrest Croft Surgery, Yardley Wood, Birmingham, UK
  1. Correspondence to: S R Manning stephen.manning{at}doctors.org.uk
  • Accepted 9 September 2010

A 39 year old woman attends your surgery with a history of “large heavy breasts” since puberty and general unhappiness with her appearance. After taking an appropriate history, you feel that she has low self esteem, with her macromastia playing an important role. She also describes experiencing back pain and neck ache. She wants to find out whether breast reduction surgery will help her.

What issues you should cover

Macromastia is often described as disproportionately heavy breasts on an otherwise average size patient. Women generally seek consultation for breast reduction surgery because of psychological reasons, physical reasons, or both. It is important initially to distinguish between two types of patient—the one who believes she has disproportionately large breasts, but hasn’t, and the one who does have macromastia. The history and physical examination should indicate patients with true macromastia, whereas those who have distorted body appearance would benefit from further psychological assessment.

Medical or social history

  • Personal or family history of breast cancer.

  • Previous breast surgery.

  • Diabetes.

  • History of or high risk of keloid scarring.

  • Smoking.

  • Body mass index and stability of weight (however, history of past significant weight changes might be more appropriate).

  • Drugs such as anticoagulant or antiplatelet agents.

  • Future wishes and intentions relating family size and to breast feeding.

Physical examination

Physical examination should include inspection and palpation. We recommend a chaperone for all doctors of either sex, but a chaperone essential for male doctors.

  • Inspection: look for bra strap marks, intertrigo, ulceration, breast ptosis, and asymmetry.

  • Palpation: oncological examination including axilla.

Other factors to include in the physical examination are:

  • Height and weight or BMI.

  • Mammography. Patients should …

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