Background:Breast reduction is one of the most common of all reconstructive plastic surgery procedures. Large heavy breasts produce back, shoulder and neck pain as well as poses clothing and social concerns. While breast reduction does result in substantial length of scars, it produces highly satisfied patients despite this aesthetic tradeoff. The improvement in pain and having bras and clothes that fit make the scars a generally well-accepted liability.
While large breasts (macromastia) occur across all ethnic groups, it is disproportionately more common amongst African-American women. I would estimate that more than half of my Indianapolis breast reduction patients are African-American even though that does not reflect the region’s population ratio. Many African-American breasts are quite large and it is not uncommon to have bra sizes that range from G to J.
One of the main concerns about breast surgery in African-Americans is the risk of adverse scarring. Given the location and amount of scarring, this is a very legitimate concern. Scarring concerns are about either thick scarring (hypertrophic scars) or that of keloids. (pathologic scarring) These two scar problems, while often used interchangeably, are not the same and are quite different. Hypertrophic scars are wide scars that are slightly raised but remain within the boundaries of the scar’s width. Keloid scarring is a genetically inherited disorder where the scar runs wild, growing and overflowing the scar’s borders. Prior laceration or surgical history will reveal if one is a keloid-former. If they are then breast reduction surgery should be avoided.
Case Study: This 35 year-old African-American female wanted a breast reduction procedure due to her back and neck pain and grooves in her shoulders. She wore a 38 DD bra and much of her breast tissue hang over and below her inframammary crease. Her areolar diameter was enlarged at 55mms. Her sternal notch to nipple distance was 29 cms and the nipple to inframammary fold distance was 12 cms.
Under general anesthesia, a breast reduction was performed on both sides using an inferior pedicle technique. The areolas were reduced to 42mms in diameter. A total of 625 grams was removed from the right side and 640 grams from the left side. Her procedure was done as an outpatient. All incisions were closed with sutures underneath the skin and were taped afterwards. She went home in a bra with a drain on each side.
She returned to the office the next day to have her drains removed. She showered afterwards and there is no concern about getting the tapes wet. The tapes were removed 10 days after surgery. She continued to wear a soft bra and returned to work two weeks after the procedure.
At eight weeks after surgery, no signs of hypertrophic scars were evident nor do I anticipate any. I have yet to see any adverse scarring in African-American breast surgery is they did not have a prior history of scarring issues elsewhere.
Case Highlights:
1) Breast reduction is a common request amongst African-American women and is highly successful at musculoskeletal relief and breast shape improvement.
2) The techniques for breast reduction in African-Americans are no different other than a more frequent consideration for a free nipple grafting method in cases of gigantomastia.
3) While the risk of hypertrophic scarring and keloid formation is greater in this ethnic group, it is not a scar problem that I have yet observed in my breast reduction patients.
Dr. Barry Eppley
Indianapolis, Indiana