Reduction Mammaplasty in a Developing Country: A Guideline for Plastic Surgeons for Patient Selection

BACKGROUND: In Ghana and most developing countries there has been no standardized study of reduction mammaplasty (RM) in patients with symptomatic macromastia (SM), despite its debilitating effects. This study aimed to analyze the physical and psychological effects associated with female patients who underwent reduction mammaplasty and to develop a guideline for plastic surgeons in developing countries to know the most important signs and symptoms to consider in SM patients. METHODS: From 2003 to 2009, all females with SM who visited Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, for RM were given a questionnaire designed to evaluate SM-related physical and psychological effects. These patients were then provided the same questionnaire at their final visit 5 months postoperatively to assess the effects of RM on SM. RESULTS: Sixty-three patients who underwent RM were evaluated, with a mean age of 28.5 years. Twenty-seven (42.9%) patients reported that their macromastia started during puberty, with 3 (4.8%) patients associating the onset with pregnancy. Thirty (47.6%) patients reported having SM for more than 10 years. Multiple regression analysis revealed upper- and lower-back pain (p = 0.0005), painful bra strap grooves (p = 0.0041), teasing (p = 0.01), and poor self-image (p = 0.021) to be significant factors for which patients underwent RM. Postoperatively, most of the patients’ physical symptoms resolved, while 2 (3.2%) patients complained of residual psychological effects. CONCLUSION: RM offers substantial symptomatic relief for patients with SM and results in significant improvement in the patient’s quality of life. This study conclusively demonstrates that, upper- and lower-back pain, painful bra strap grooves, teasing, and poor self-image should be considered by plastic surgeons before deciding which SM patient to treat when confronted with numerous SM patients.