Macromastia (large breasts): request for breast reduction
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5408 (Published 13 October 2010) Cite this as: BMJ 2010;341:c5408
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Shokrollahi and colleagues elegantly outlined the important aspects
related to breast reduction. 1
However, they failed to discuss antiretroviral treatment (ART) induced
macromastia.
This occurs as a result of lipodystrophy syndrome which is a
known complication of protease inhibitors especially indinavir. 2 The
prevalence of macromastia with protease inhibitors varied from 1 to 13 %.
3 This complication has also been reported with other classes of ART. 4 In
the majority of cases macromastia resolves spontaneously or by change of
ART. 5 Reassurance and a change of ART may avoid unnecessary breast
reduction surgery and its complications in those populations.
1. Shokrollahi K, Whitaker S, Mannasiev D, Hiew L Y, Cooper M A C S.
Macromastia (large breasts): request for breast reduction. BMJ 2010; 341:
c5408.
2. Herry I, Bernard L, de Truchis P, Peronne C. Hypertrophy of the breasts
in a patient treated with indinavir. Clin Infect Dis 1998; 26: 1482.
3. Safrin S, Grunfeld C. Fat redistribution and metabolic changes in
patients with HIV infection. AIDS 1999; 13: 2493-505.
4. Mercie P. Efavirenz-associated breast hypertrophy in HIV-infected
patients. AIDS 2002; 15: 126-29.
5. Chima-Okereke C, Yoganathan K, Blackwell A. Antiretroviral induced
gynaecomastia - does it need to be treated? MSSVD/SSGNM Spring Meeting
Oslo 15-18 May 2002.
Katie Yoganathan
4th year Medical Student
Cardiff Medical School.
Competing interests: No competing interests
Informed Consent and Chronic Scar Pain
Editor --
Shokrollahi et. al. list risks of breast reduction surgery[2]. They
conveniently forgot about long-term scar pain, mentioning just about
nipple hypersensitivity.
The prevalence of chronic pain after breast surgery ranges from 11 to
49%[3]. This holds true for non-cancer, cosmetic surgery as well [4, 5,
1].
Patients often report that their surgeons ignore or belittle their pain,
while their general practitioners do not believe the reality of their
pain, suffering, and disability, considering it to be ``all in your
head'', an expression of the same psychosocial factors which led to
plastic surgery in the first place.
Consent for elective surgery cannot be informed, if it ignores a
common and potentially disabling complication.
References
[1] Luis Romundstad, Harald Breivik, Helge Roald, Knut Skolleborg,
Pal Richard
Romundstad, and Audun Stubhaug. Chronic pain and sensory changes
after augmentation mammoplasty: Long term effects of preincisional
administration of methylprednisolone. Pain, 124(1-2):92 - 99, Sep
2006. URL: http://www.sciencedirect.com/pain/article/B6T0K-4JVTC0B-
4/2/80b6ffda4cf029633c56ca844c4a291a.
[2] K Shokrollahi, I S Whitaker, S R Manning, D Mannasiev, L Y Hiew,
and
M A C S Cooper. Macromastia (large breasts): request for breast reduction.
BMJ, 341, 2010. URL: http://www.bmj.com/content/341/bmj.c5408.short.
[3] Audun Stubhaug and Harald Breivik. Prevention and treatment of
hyperalge-
sia and persistent neuropathic pain after surgery. In H Breivik and M
Shipley,
editors, Pain: Best Practice and Research Compendium, chapter 26, pages
281
- 286. Elsevier, Edinburgh, 2007.
[4] Niek van Elk, Monique A Steegers, Leo-Peter van der Weij, Andrea
W Evers,
Ed H Hartman, and Oliver H Wilder-Smith. Chronic pain in women after
breast augmentation: Prevalence, predictive factors and quality of life.
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journal of pain (London, England), 13(6):660 - 661, Jul 2009. URL:
http://linkinghub.elsevier.com/retrieve/pii/S1090380109000743.
[5] Marie L von Sperling, Hilde Hoimyr, Kenneth Finnerup, Troels S
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and Nanna B Finnerup.
Persistent pain and sensory changes following cosmetic breast
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European journal of pain (London, England), page in press, Aug 2010. URL:
http://linkinghub.elsevier.com/retrieve/pii/S1090380110001709?showall=true.
Competing interests: No competing interests