Examination

Examination in breast reduction surgery should focus on the following areas:

• general examination:
  • size of frame
  • proportionate size of torso
  • scoliosis
  • rib visibility
  • chest wall deformities
  • previous scars and quality of scarring
  • lymphadenopathy
• skin:
  • quality eg thickness, elasticity; pinch skin to assess skin thickness
  • skin conditions eg eczema
  • intertrigo, particularly in the submammary fold
  • stretch marks
  • guttering of bra straps into shoulders
• nipple/areola complex (NAC):
  • nipple:
    • projection
    • inversion
  • areola:
    • size
    • pigmentation
  • position of NAC in relation to inframmary fold - degree of ptosis of NAC
  • symmetry of NAC's
• breast mound:
  • size of breast
  • symmetry
  • position of breast volume on chest wall and within skin envelope - degree of ptosis of gland (Regnault's classification of breast ptosis)
  • axillary tail prominence
  • masses

For planning breast reduction surgery, the following measurements are vital:

• chest circumference for assessing breast and bra sizing:
  • at level of maximum breast projection
  • at level of inframammary fold
• nipple distance to sternal notch
• inter-nipple distance
• nipple distance to inframammary fold