The results of breast reduction surgery and the study of the factors that influence it

Aim: Breast reduction surgery is not an operation performed solely for aesthetic concerns. It is a surgical intervention that aims to enhance the quality of life of patients, particularly those afflicted with breast hypertrophy, by alleviating symptoms that impede daily functioning and providing functional improvement. The objective of this study was to evaluate the effects of breast reduction surgery on pulmonary function, posture, pain level, psychosocial parameters, physical activity capacity and to assess the surgical and patient-related factors that influence these outcomes. Material and Method: Thirty seven patients who had breast reduction surgery between 12/01/2023 and 10/01/2024 at the Inonu University Faculty of Medicine Turgut Özal Medical Center Plastic, Reconstructive and Aesthetic Surgery clinic were included in the study. Individuals with previous breast surgery were excluded and patients' demographic data, surgical techniques, anthropometric measurements, metabolic values, postural changes, respiratory functions, psychosocial status, and physical activity levels were thoroughly reviewed. Results: There was no significant difference in pulmonary function test parameters between preoperative and postoperative period (p>0.05). It was found that the change in best/predictive value of Maximal Mid Expiratory Flow Rate in the preoperative and postoperative periods was close to the significance level (p=0.059). In the course of psychological evaluations, a statistically significant decrease in Beck Depression Inventory scores was observed (preoperative mean = 11,46; postoperative mean = 9,76; p = 0,028). In the analysis of anxiety-depression levels, a remarkable decrease was found in Hospital Anxiety and Depression Scale-D scores (preoperative mean = 6,54; postoperative mean = 4,92; p = 0,029), while no significant difference was observed in Hospital Anxiety and Depression Scale-A scores (preoperative mean = 6,70; postoperative mean = 5,78; p = 0,121). The analysis revealed a decrease in pain scores, with the Neck Disability Questionnaire score from 12,97 ± 7,21 preoperatively to 8,16 ± 5,41 postoperatively (p = 0,001). The Oswestry Low Back Pain Disability Questionnaire score also demonstrated an improvement, dropping from 0,20 ± 0,12 to 0,12 ± 0,11 (p = 0,003). In the present study, Body Mass Index (p<0,001), pedicle type (p = 0,028) and total amount of excision (p <0,001) were found to have a meaningful effect on the change in McGill-Melzack Pain Questionnaire score. The International Physical Activity Questionnaire was utilized in our study to investigate the impact of breast reduction surgery on enhancing physical activity capacity. The preoperative values of 953,03 ± 1389,52 increased to 1246,49 ± 1391,43 in the postoperative period (p = 0,012). Thoracic kyphosis angle decreased from 42,47° ± 7,23° to 39,08° ± 7,28° (p <0,001). The cervical lordosis angle increased from 17,94° ± 2,24° to 19,58° ± 2,27° (p <0,001). Additionally, the lumbar lordosis angle showed a reduced trend from 46,96° ± 7,52° to 45,14° ± 7,75° (p <0,001) and the sacral inclination angle decreased from 40,31° ± 7,27° to 38,13° ± 6,20° (p <0,001). In addition, the results of the New York Posture Evaluation Test demonstrated an improvement in patients' posture scores from 45,51 ± 6,69 to 52,59 ± 7,17 in the postoperative period (p <0,001). This finding suggests that surgical intervention led to an enhancement in patients' overall postural posture. No statistically significant change was found between the preoperative and postoperative periods in terms of desire, arousal, lubrication, orgasm, and sexual satisfaction (p>0,05). The Pittsburgh Sleep Quality Index was used to evaluate the effect on sleep quality. The mean score was 6,27 ± 2,66 preoperatively and 6,03 ± 3,42 postoperatively. (p= 0,336). When patients' satisfaction with the surgery and its results were examined using the BREAST-Q scale, it was recorded that psychosocial (p<0,001), sexual (p=0,025) and breast well-being (p<0,001) scores showed a significant increase in the postoperative period. Conclusion: Breast reduction surgery provides physical and psychosocial improvement depending on factors such as age, body mass index, chronic diseases, surgical technique and the amount of tissue removed. Key Words: Breast hypertrophy, Breast reduction, Macromastia, Life Quality