Clinical and quality of life outcomes following reduction mammoplasty for symptomatic macromastia among Sri Lankan women: a prospective cohort study

Background: The impact of macromastia is unfortunately underestimated among the developing South Asian countries. The resulting distress can make it challenging for patients to be physically active and affect their quality of life (QoL). Reduction mammoplasty is a standard treatment option for people suffering from symptomatic macromastia. Therefore we aimed to evaluate the efficacy of reduction mammoplasty in alleviating symptoms of macromastia and its impact on quality of life among Sri Lanka females. Methods A prospective study was conducted among 48 patients who underwent reduction mammoplasty in a surgical unit at National Hospital of Sri Lanka from 2016 January to 2021 January. SF-36 questionnaire which is validated in Sri Lanka was used to assess the quality of life. To assess pain related to macromastia, a visual analogue scale was used from 0 to 10 according to the level of intensity. The outcomes were assessed one week prior to surgery and at 2 weeks and 6 months after surgery. Results Median age was 43 years and median BMI was 26.8 kg/m2. The commonest presentation was breast and musculoskeletal pain (100%), shoulder grooving (81.3%) and sub-mammary intertrigo (37.5%). The average duration of symptoms was 2 years. All patients initially being reluctant to seek medical advice. Only 10.4 % of patients were aware of availability of treatment. Wise pattern reduction mammoplasty was performed in 79.2%. The commonest complications were wound dehiscence (4/48) followed by surgical site infection (2/48) and nipple necrosis (1/48). There was a significant improvement in satisfaction with breast aesthetics and reduction in pain following surgery. There was also an improvement in all 8 domains of the quality of life following surgery in comparison to the pre-operative scores especially in general health, pain and physical functions. Conclusion Our study clearly demonstrated that reduction mammoplasty caused a significant improvement in the overall quality of life and psychological wellbeing with significant reduction in pain for patients suffering from macromastia. Creating more awareness among the public to encourage women to openly discuss about breast related symptoms and to overcome socio cultural taboos and barriers is a timely necessity.