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