Complications and Satisfaction After Adolescent Breast Reduction for Juvenile Macromastia: Systematic Review and Meta-analysis

Abstract

Background: Juvenile macromastia is a rare condition of significant breast enlargement in adolescents. Reduction mammoplasties offer relief, but data on complications in adolescents are rare as opposed to data on adults. We reviewed the outcomes, complications, recurrence, and patient satisfaction after reduction mammoplasties in adolescents.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a thorough search across various electronic databases for "juvenile macromastia" and "breast reduction." Only studies on women diagnosed with juvenile macromastia before 21 years of age who underwent breast reduction surgery were included. The methodological index for nonrandomized studies was used to assess study quality.

Results: This meta-analysis pooled data from 11 studies. The overall pooled postoperative complication rate, based on random-effects models, was 17.5% (95% confidence interval: 9.7%-29.5%). The recurrence rate was 15.6% (95% confidence interval: 8.5%-26.9%), ranging from 0% to 52.9%. Complication rates varied widely across studies, with wound dehiscence, hematoma, and infection being the most common. Severe complications, such as nipple necrosis, were rare. Low publication bias was observed for postoperative complications, but potential bias was noted for recurrence outcomes.

Conclusions: The findings emphasize the need for standardized reporting and long-term follow-up to improve the reliability of pooled estimates and to guide clinical decision-making. The high recurrence risk emphasized the need for individualized surgical approaches and careful management of risk factors, such as obesity and smoking, to improve outcomes. Despite the variability, the benefits of surgery generally outweighed the risks, with high patient satisfaction reported in the included studies.

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart indicating selection of articles for this systematic review.

Fig. 2.

Forest plot and results of the meta-analysis of all complications associated with breast reduction surgery in adolescents with juvenile macromastia and macromastia.

Fig. 3.

Funnel plot of the meta-analysis of all complications associated with breast reduction surgery in adolescents with juvenile macromastia.

Fig. 4.

Forest plot and results of the meta-analysis of recurrence after breast reduction surgery in adolescents with juvenile macromastia.

Fig. 5.

Funnel plot of the results of meta-analysis of recurrence after breast reduction surgery in adolescents with juvenile macromastia.