OBJECTIVE
To develop the interdisciplinary algorithm for complex treatment of macromastia associated with benign breast dysplasia and comorbidities.
MATERIAL AND METHODS
We analyzed the results of reduction mammoplasty in 155 patients with dyshormonal macromastia and obesity. The follow-up period was 4 years. Age of patients ranged from 24 to 55 years, BMI — 27—35 kg/m2. All patients of working age underwent clinical examination including lipid profile and gynecological screening to exclude cancer. The following surgeries were performed: procedures by D. Hammond, D. Goulian and E. Hall-Findlay for localization in the upper-outer quadrant; D. Hammond, E. Hall-Findlay — in the upper-inner quadrant; Strombeck procedure — in central part; E. Hall-Findlay and M. Lejour — in the lower-inner and lower-outer quadrants. Combined treatment of patients with BMI > 30 kg / m2 and comorbidities implied postoperative pharmacotherapy with metformin, Ozempic, L-thyroxine, dostinex. To assess treatment effectiveness, we used the international BREAST-Q questionnaires and the WAI scale.
RESULTS
One year after treatment onset, 50 patients noted decrease or disappearance of pain and swelling syndrome, 45 out of 55 patients — body weight loss. Lower ultrasonic density of mammary glands was recorded in 32 patients. Refusal of medications for correction of mastodynia was recorded in all patients of both groups. Performance increased in all patients.
CONCLUSION
Surgery and correction of metabolic disorders can break the vicious circle in dyshormonal chain where the target organ is mammary gland tissue. Reduction mammoplasty motivated patients to lose weight and change lifestyle in early and late postoperative period. Surgical treatment of macromastia associated with benign breast dysplasia and comorbid pathology can be used as a first-line treatment for this pathology based on interdisciplinary approach. The last one consists of body weight correction, normalization of reproductive function and, as a consequence, QoL improvement.
