Adolescent Breast Reduction and Gynecomastia Surgery: BMI Comparisons and Correlations

Background:

Adolescent breast enlargement can be a deforming, distressing, and disabling condition. Presenting symptoms and complication rates of adolescent breast reduction patients have been reported to mirror those seen in the adult population.¹ Compared with their adult counterparts, the adolescent population may display greater rates of obesity and social distress prior to surgery.¹ Benefits of breast reduction can include resolution of pain, improved quality of life, extroversion, and emotional stability.² There is some data to suggest in adults, breast reduction may promote physical activity and weight loss post-operatively.³ There is unfortunately a paucity of literature regarding these types of outcomes for the growing number of adolescents seeking breast reduction or gynecomastia surgery.

Methods: A retrospective study was undertaken to compare pre- and post-operative BMIs for adolescents undergoing surgery for mammary hyperplasia and gynecomastia over a 13 year period from 2002 to 2015.

Results: A total of 69 females and 64 males were identified. Mean age at time of surgery for females was 17.1 years and 15.6 years for males. This difference is statistically significant (p<0.0001).  Average pre-operative BMI for females was 30.7 (SD 6.1) compared to males at 27.8 (SD 6.0).  This difference is also significant (p=0.007).  Only 20.1% of females had a normal BMI compared to 26.5% who were overweight and 52.9% who were obese. No patients were underweight.  For the males, 3.1% were underweight, 31.3% were normal weight, 31.3% were overweight, and 34.4% were obese. Average total tissue resection weight was 1384.5 gm in females and 218.6 gm in males. The correlation coefficients of total resection weight and BMIs was r=0.57 for females and r=0.67 in males. 49.3% of females and 59.4% of males had 6 months or more of post-operative weight data recorded.  Of these patients the majority of both females (79.4%) and males (75.7%) remained overweight or obese post-operatively. Comparison of pre-operative versus post-operative BMIs showed no significant differences for females or males (p=0.36 and p=0.15, respectively).

Conclusion: The majority of adolescent patients presenting with mammary hyperplasia or gynecomastia requesting surgery are overweight or obese.  More than half of females were obese with a BMI >=30 compared to one third of males.  Females are more likely to undergo surgery at a later age than their male counterparts. There is a moderate to strong positive correlation between pre-operative BMI and amount of breast tissue removed at surgery. Post-operatively patients who are followed long-term do not show a significant decrease in BMI with at least three-fourths of both male and female patients remaining overweight or obese.

 

References:

¹Koltz PF, Myers RP, Shaw RB, et al. Reduction mammoplasty in the adolescent female: the URMC experience. International Journal of Surgery.  99 (2011): 229-232.

²Iwuagwu OC, Walker LG, Stanley PW, et al. Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.  British Journal of Surgery.  2006. 93(3):291-294.

³Singh KA, Pinell XA, and Losken A. Is Reduction Mammaplasty a Stimulus for Weight Loss and Improved Quality of Life?  Annals of Plastic Surgery.  May 2010; 64(5):585-587.