Body Weight Trends Upwards After Breast Reduction Surgery in Teens
Focus on lifestyle changes to prevent weight gain, suggests study in Plastic and Reconstructive Surgery®

Many adolescents and young women gain weight in the years after breast reduction surgery – particularly those who were at a healthy body mass index (BMI) before surgery, reports a paper in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our experience suggests that BMI and body trend upwards after reduction mammaplasty in teens and young women," comments lead author William N. Doyle Jr, a medical student at University of South Florida Morsani College of Medicine, Tampa. "These patients should be targeted for healthy lifestyle changes to prevent weight gain."

Follow-up data on weight changes after breast reduction surgery

Reduction mammaplasty can relieve debilitating symptoms such as neck, back and shoulder pain and improve psychological well-being in women with overlarge breasts (macromastia). Previous studies have raised concern that obesity may be a risk factor for increased complication rates in adolescents with macromastia. Many plastic surgeons encourage patients to lose weight before breast reduction surgery.

Some reports have suggested that reduction mammaplasty leads to postoperative weight loss, perhaps by alleviating physical symptoms that can make it difficult to exercise. The new study examined long-term changes in body weight in adolescents and young women undergoing breast reduction surgery.

The study included 56 patients aged 21 years or younger (average 18.6 years) who underwent reduction mammaplasty between 2015 and 2019. Changes in body weight and BMI were assessed over a median follow-up of 46 months. Before surgery, 28.6% of patients had a BMI in the healthy range (18.5 to 24.9 kilograms per square meter of height). The rest had an initial BMI in the overweight (25.0 to 29.9 mg/m²) or obese range (30 kg/m²) or higher.

Trend toward greater weight gain in women with initially healthy BMI

At follow-up, just 22 patients had a decrease in BMI: a rate of 39.3%. Body weight and BMI decreased slightly in the first year after breast reduction, but increased with longer follow-up. Body weight increased by a median of three percent and BMI by five percent.

Among women with initially healthy BMI, both body weight and BMI increased steadily. In contrast, patients who were initially overweight had lesser increases in weight, while those who were obese had no significant change in body weight or BMI. With adjustment for other factors, weight changes after breast reduction were not significantly related to initial BMI, patient age or amount of tissue removed.

Why did these young women gain weight after reduction mammaplasty? Hormonal or metabolic changes after puberty could play a role. "Another theory is that healthy lifestyle habits, including exercise and a balanced diet, are not established postoperatively," the researchers write. Further studies of patient behaviors and attitudes toward lifestyle change would be needed to explore these factors.

"Reduction mammoplasty alone is not sufficient to stimulate sustained weight loss for

adolescent females, regardless of their preoperative BMI classification," Mr Doyle and coauthors conclude. They propose that young women undergoing this procedure be targeted for measures to promote healthy lifestyles – ideally in a multidisciplinary approach including nutrition, fitness coaching and close follow-up with a primary care provider.

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Monitoring Postoperative Weight Changes following Reduction Mammaplasty in Adolescents"

Article: "Monitoring Postoperative Weight Changes following Reduction Mammaplasty in Adolescents" (doi: 10.1097/PRS.0000000000011676)