eMedicine Specialties > Plastic Surgery > Breast

Breast Reduction, Amputation: Workup

Author: Curtis S F Wong, MD, Clinical Instructor, Department of Family Practice, Division of Surgery, Mercy Medical Center
Contributor Information and Disclosures

Updated: Oct 15, 2009

Workup

Laboratory Studies

  • Perform a complete blood count to ensure anemia (hemoglobin <10 g) or thrombocytopenia are not present. (As blood loss with this procedure should be minimal, the author does not recommend autogenous banking of blood.)
  • Provide photographic documentation to the insurance company for authorization and for comparison of before and after photos to help the patient appreciate what has changed.
  • Other laboratory tests may be indicated depending on the additional health problems the patient may have or the medications she may be taking. This includes prothrombin time, activated partial thromboplastin time, complete or basic metabolic profiles, and urinalysis. An ECG is performed if indicated by the patient's history or if required by the surgical facility.

Imaging Studies

  • Mammogram
    • It is indicated in any patient who is 40 years or older and has not undergone one in the prior 6-9 months. This is in compliance with the guidelines established by the American Cancer Society.
    • The author also considers mammography in patients older than 30 years when they have a strong family history of breast cancer.
    • Mammography (and possibly ultrasound or other imaging studies) is also used in the evaluation of palpable masses noted on physical examination.
    • Postoperative baseline mammograms are obtained approximately 6 months after the surgery or at the discretion of the surgeon. This is to provide a baseline for comparison with future mammograms and document what changes may have occurred following surgical intervention.
  • Obtain chest radiographs if indicated by examination findings or the patient's history.

Other Tests

  • An ECG is performed if a patient's history warrants. In addition, some surgical facilities have guidelines requiring ECGs at certain patient ages.

Diagnostic Procedures

  • Manual lifting of the breasts may result in considerable relief or resolution of symptoms. This is a strong indicator that the procedure will result in relief for the patient.
  • Progression of symptoms over the course of the day when upright and wearing a bra also support the probability of a health benefit following reduction surgery.

Histologic Findings

Tissue is sent for pathologic examination to rule out carcinoma or other atypia.

More on Breast Reduction, Amputation

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References
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References

  1. McKissock P. Color Atlas of Mammaplasty. Thieme Medical Publishers;1991:47-78.

  2. Hawtof DB, Levine M, Kapetansky DI, Pieper D. Complications of reduction mammaplasty: comparison of nipple-areolar graft and pedicle. Ann Plast Surg. Jul 1989;23(1):3-10. [Medline].

  3. American Society of Plastic and Reconstructive Surgeons. Clinical Practice Guidelines for Female Breast Hypertrophy/Breast Reduction. 1993.

  4. Robbins TH. Reduction mammaplasty by the Robbins technique. Plast Reconstr Surg. Feb 1987;79(2):308-9. [Medline].

  5. Jackson IT, Bayramicli M, Gupta M, Yavuzer R. Importance of the pedicle length measurement in reduction mammaplasty. Plast Reconstr Surg. Aug 1999;104(2):398-400. [Medline].

  6. Koger KE, Sunde D, Press BH. Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation. Ann Plast Surg. Nov 1994;33(5):561-4. [Medline].

  7. Abramson DL. Increasing projection in patients undergoing free nipple graft reduction mammoplasty. Aesthetic Plast Surg. Jul-Aug 1999;23(4):282-4. [Medline].

  8. Fredricks S. Re: Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation. Ann Plast Surg. May 1995;34(5):559. [Medline].

  9. Matarasso A, Wallach SG, Rankin M. Reevaluating the need for routine drainage in reduction mammaplasty. Plast Reconstr Surg. Nov 1998;102(6):1917-21. [Medline].

  10. Bostwick J. Plastic and Reconstructive Breast Surgery. 2nd ed. Quality Medical Publishing; 2000.

  11. Casas LA, Byun MY, Depoli PA, Gradinger GP. Maximizing breast projection after free-nipple-graft reduction mammaplasty. Plast Reconstr Surg. Apr 1 2001;107(4):961-4. [Medline].

  12. Farina R, Villano JB. Reduction mammaplasty with free grafting of the nipple and areola. Br J Plast Surg. Oct 1972;25(4):393-8. [Medline].

  13. Letterman G, Schurter M. A comparison of modern methods of reduction mammaplasty. South Med J. Oct 1976;69(10):1367-71. [Medline].

  14. Netscher D. Mammography and Reduction Mammaplasty. Aesthetic Surg J. 1999;19(6):445.

  15. Schnur PL, Hoehn JG, Ilstrup DM, et al. Reduction mammaplasty: cosmetic or reconstructive procedure?. Ann Plast Surg. Sep 1991;27(3):232-7. [Medline].

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Further Reading

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Keywords

breast reduction, breast amputation, reduction mammaplasty, nipple graft mammaplasty, amputation mammaplasty, free nipple graft, free nipple transplantation, mammogram, breast flaps, WISE pattern excisions

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Contributor Information and Disclosures

Author

Curtis S F Wong, MD, Clinical Instructor, Department of Family Practice, Division of Surgery, Mercy Medical Center
Curtis S F Wong, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and California Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, Assistant Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, University of Alabama at Birmingham and Kirklin Clinics
James Neal Long, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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