Summary: A study in Plastic and Reconstructive Surgery found that many adolescents and young women gain weight after breast reduction surgery, particularly those with an initially healthy BMI, suggesting the need for targeted lifestyle interventions to prevent postoperative weight gain.

Key Takeaways

  • Postoperative Weight Gain: Many adolescents and young women experience weight gain after breast reduction surgery, particularly those with an initially healthy BMI.
  • Long-Term BMI Trends: While some patients see a slight initial weight decrease, body weight and BMI tend to increase over time, with overweight and obese patients showing smaller changes than those with a healthy BMI.
  • Need for Lifestyle Interventions: The study suggests that breast reduction alone does not lead to sustained weight loss, highlighting the importance of postoperative lifestyle guidance, including nutrition and fitness coaching, to prevent weight gain.

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Many adolescents and young women gain weight in the years after breast reduction surgery—particularly those who were at a healthy body mass index (BMI) before surgery, reports a paper in the February issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Our experience suggests that BMI and body trend upwards after reduction mammaplasty in teens and young women,” says lead author William N. Doyle, Jr., a medical student at University of South Florida Morsani College of Medicine, Tampa. “These patients should be targeted for healthy lifestyle changes to prevent weight gain.”

Weight Changes Post-Breast Reduction Follow-up

Reduction mammaplasty can relieve debilitating symptoms such as neck, back and shoulder pain and improve psychological well-being in women with overlarge breasts (macromastia). Previous studies have raised concern that obesity may be a risk factor for increased complication rates in adolescents with macromastia. Many plastic surgeons encourage patients to lose weight before breast reduction surgery.

Some reports have suggested that reduction mammaplasty leads to postoperative weight loss, perhaps by alleviating physical symptoms that can make it difficult to exercise. The new study examined long-term changes in body weight in adolescents and young women undergoing breast reduction surgery.

The study included 56 patients aged 21 years or younger (average 18.6 years) who underwent reduction mammaplasty between 2015 and 2019. Changes in body weight and BMI were assessed over a median follow-up of 46 months. Before surgery, 28.6% of patients had a BMI in the healthy range (18.5 to 24.9 kilograms per square meter of height). The rest had an initial BMI in the overweight (25.0 to 29.9 mg/m2) or obese range (30 kg/m2) or higher.

Higher Weight Gain Trend in Women with Healthy BMI

At follow-up, just 22 patients had a decrease in BMI: a rate of 39.3%. Body weight and BMI decreased slightly in the first year after breast reduction but increased with longer follow-up. Body weight increased by a median of three percent and BMI by five percent.

Among women with initially healthy BMI, both body weight and BMI increased steadily. In contrast, patients who were initially overweight had lesser increases in weight, while those who were obese had no significant change in body weight or BMI. With adjustment for other factors, weight changes after breast reduction were not significantly related to initial BMI, patient age or amount of tissue removed.

Why did these young women gain weight after reduction mammaplasty? Hormonal or metabolic changes after puberty could play a role. “Another theory is that healthy lifestyle habits, including exercise and a balanced diet, are not established postoperatively,” the researchers write. Further studies of patient behaviors and attitudes toward lifestyle change would be needed to explore these factors.

“Reduction mammoplasty alone is not sufficient to stimulate sustained weight loss for adolescent females, regardless of their preoperative BMI classification,” Doyle and his coauthors conclude. They propose that young women undergoing this procedure be targeted for measures to promote healthy lifestyles—ideally in a multidisciplinary approach including nutrition, fitness coaching, and close follow-up with a primary care provider.