History
When assessing a patient for breast reduction surgery, the history is a vital to establish likely benefits, risks and fitness for surgery. Key spheres include:
- symptoms and signs from breast hypertrophy:
- neck and back ache
- mastalgia
- bra straps cutting into shoulders
- poor posture
- intertrigo
- upper limb neurological symptoms
- interference with daily activities eg buying clothing, exercise
- psychological history:
- motivation for surgery
- lack of confidence or self-esteem
- bullying
- reduced social interaction
- psychosexual problems including embarrassment and difficulty in sexual relations
- breast history:
- current bra size
- ideal size and shape of breasts
- difference in size between breasts
- recent change in breast size and dependence on weight, OCP, menses - ideally surgery only when breast size is static
- nipple/areola complex:
- happiness with size, shape and position
- sensation - may change adversely with surgery
- breast cancer history:
- previous personal history or family history of breast cancer
- lumps
- nipple discharge
- previous breast cancer surgery
- recent mammogram results
- breast feeding:
- future plans to breast feed - surgery may prevent
- future pregnancies planned - may cause further increase in breast size
- scarring history; hypertrophic or keloid scarring and treatment
- general medical history:
- current weight and height to calculate BMI
- medical problems that may affect general anaesthesia eg ischaemic heart disease, diabetes, asthma
- drug history eg OCP, anticoagulants
- smoking history
- allergies
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