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February 1997, Vol 151, No. 2 >
Article | February 1997

Outcome for Patients With Bulimia and Breast Hypertrophy After Reduction Mammaplasty FREE

Richard E. Kreipe, MD; Alice G. Lewand, MD; Carolyn P. Dukarm, MD; Elethea H. Caldwell, MD
Arch Pediatr Adolesc Med. 1997;151(2):176-180. doi:10.1001/archpedi.1997.02170390066012.
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Objectives:  To determine the outcome of patients with bulimia nervosa and symptomatic breast hypertrophy (macromastia) who had reduction mammaplasty and to identify factors that were associated with positive outcomes.

Design:  Case series with semistructured, retrospective, personal interviews performed an average of 4 years after the procedure.

Setting:  University hospital–based adolescent eating disorder program.

Patients:  Five adolescent and young adult females who had been treated for bulimia nervosa and underwent reduction mammaplasty.

Outcome Measures:  Presurgical and postsurgical report of physical symptoms, body image and weight control habits, ability to exercise, psychosocial functioning, and self-esteem.

Results:  All patients experienced improvement in physical symptoms (pain and inframammary dermatitis), in their posture, and in their ability to find clothes that fit properly, to exercise, and to avoid embarrassment in social situations. Preoperative eating disorder habits were a dysfunctional attempt to achieve more "normal" body proportions; postoperatively, symptoms of an eating disorder were completely eliminated or greatly reduced. Factors related to favorable outcome included professional validation of patient's symptoms, realistic patient expectations from the surgical procedure, supportive family dynamics, and ongoing treatment for the eating disorder.

Conclusion:  This series of patients with bulimia nervosa and macromastia experienced significant improvement in symptoms related to their eating disorder and their breast hypertrophy following reduction mammaplasty.Arch Pediatr Adolesc Med. 1997;151:176-180

REFERENCES

1 +
Phillips KA, Kim JM, Hudson JI.  Body image disturbance in body dysmorphic disorder and eating disorders: obessions or delusions? Psychiatr Clin North Am . 1995;;18:317-334.
2 +
Yates A, Shisslak CM, Allender JR, Wolman W.  Plastic surgery and the bulimic patient . Int J Eat Disord . 1988;;7:557-560.
3 +
McIntosh VV, Britt E, Bulik CM.  Cosmetic breast augmentation and eating disorders . N Z Med J . 1994;;107:151-152.
4 +
Harris DL.  Self-consciousness of disproportionate breast size: a primary psychological reaction to abnormal appearance . Br J Plast Surg . 1981;;36:191 -195.
5 +
Goin MK, Goin JM, Gianini MH.  The psychic consequences of a reduction mammaplasty . Plast Reconstr Surg . 1977;;59:530-534.
6 +
Vaz FJ, Salcedo MS.  Breast hypoplasia as an initiating factor in anorexia nervosa . Psychosomatics . 1993;;34:372-374.
7 +
Gonzalez L, Walton RL, Shafer V, Matory WE, Borah GL.  Reduction mammaplasty improves symptoms of macromastia . Plast Reconstr Surg . 1993;;91: 1270-1276.
8 +
Birtchnell S, Whitfield P, Lacey JH.  Motivational factors in women requesting augmentation and reduction mammaplasty . J Psychosom Res . 1990;;34:509-514.
9 +
Evans RD, Ryan JJ.  Reduction mammaplasty for the teenage patient: a critical analysis . Aesthetic Plast Surg . 1994;;18:291-297.
10 +
Hollyman JA, Lacey JH, Whitfield PJ, Wilson JSP.  Surgery for the psyche: a longitudinal study of women undergoing reduction mammaplasty . Br J Plast Surg . 1986;;39:222-224.
11 +
Serletti JM, Reading G, Caldwell E, Wray RC.  Long-term patient satisfaction following reduction mammaplasty . Ann Plast Surg . 1992;;28:363-365.
12 +
Raispis T, Zehrin RD, Downey DL.  Long-term fuctional results after reduction mammaplasty . Ann Plast Surg . 1995;;34:113-116.
13 +
Goin JM, Goin MK.  Reduction mammaplasty . In Changing the Body: Psychological Effects of Plastic Surgery . Baltimore, Md: Williams & Wilkins; 1981;: 203-209.
14 +
Trebitsch J.  Le corps et ses transformations comme objets d'investissement narcissique dans l'evolution d'une nevrose d'adolescente . Acta Psychiatr Belg . 1971;;71:488-496.
15 +
Goin MK.  Psychological reactions to surgery of the breast . Clin Plast Surg . 1982;;9:347-354.
16 +
Goin JM, Goin MK.  Psychological aspects of aesthetic plastic surgery . In: Lewis J, ed. The Art of Aesthetic Plastic Surgery . Boston, Mass: Little, Brown & Co Inc; 1989;:39-47.
17 +
Hoffman A.  Reduction mammaplasty: a medicolegal hazard? Aesthetic Plast Surg . 1987;;11:113-116.
18 +
Strombeck JO.  Long term results after reduction mammaplasty . Plast Surg . 1992;;1:529-530.
19 +
Zaworski RE.  Anorexia nervosa following a pharyngeal flap operation . Cleft Palate J . 1981;;18:223-224.
20 +
Brown DM, Young VL.  Reduction mammaplasty for macromastia . Aesthetic Plast Surg . 1993;;17:211-223.
21 +
Gifford S.  Cosmetic surgery and personality change: a review and some clinical observations . In: Goldwyn RM, ed. The Unfavorable Result in Plastic Surgery: Avoidance and Treatment . Boston, Mass: Little, Brown & Co Inc; 1984;: 21-45.
22 +
McKissock PK.  Complications and undesirable results with reduction mammaplasty . In: Goldwyn RM, ed. The Unfavorable Result in Plastic Surgery: Avoidance and Treatment . Boston, Mass: Little, Brown & Co Inc; 1984;:739-759.
23 +
Schnur PL, Hoehn JG, Ilstrup DM, Cahoy MJ, Chu CP.  Reduction mammaplasty: cosmetic or reconstructive procedure? Ann Plast Surg . 1991;;27:232-237.
24 +
Miller AP, Zacher JB, Berggren RB, Falcone RE, Monk J.  Breast reduction for symptomatic macromastia: can objective predictors of operative success be identified? Plast Reconstr Surg . 1995;;95:77-83.
25 +
Davis GM, Ringler SL, Short K, Sherrick D, Bengston BP.  Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction . Plast Reconstr Surg . 1995;;96:1106-1110.
26 +
Little JW III, Spear SL, Romm S.  Reduction mammaplasty and mastopexy . In: Smith JW, Aston SJ, eds. Grabb and Smith's Plastic Surgery . Boston, Mass: Little, Brown & Co Inc; 1991;:1157-1202.

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References

1 +
Phillips KA, Kim JM, Hudson JI.  Body image disturbance in body dysmorphic disorder and eating disorders: obessions or delusions? Psychiatr Clin North Am . 1995;;18:317-334.
2 +
Yates A, Shisslak CM, Allender JR, Wolman W.  Plastic surgery and the bulimic patient . Int J Eat Disord . 1988;;7:557-560.
3 +
McIntosh VV, Britt E, Bulik CM.  Cosmetic breast augmentation and eating disorders . N Z Med J . 1994;;107:151-152.
4 +
Harris DL.  Self-consciousness of disproportionate breast size: a primary psychological reaction to abnormal appearance . Br J Plast Surg . 1981;;36:191 -195.
5 +
Goin MK, Goin JM, Gianini MH.  The psychic consequences of a reduction mammaplasty . Plast Reconstr Surg . 1977;;59:530-534.
6 +
Vaz FJ, Salcedo MS.  Breast hypoplasia as an initiating factor in anorexia nervosa . Psychosomatics . 1993;;34:372-374.
7 +
Gonzalez L, Walton RL, Shafer V, Matory WE, Borah GL.  Reduction mammaplasty improves symptoms of macromastia . Plast Reconstr Surg . 1993;;91: 1270-1276.
8 +
Birtchnell S, Whitfield P, Lacey JH.  Motivational factors in women requesting augmentation and reduction mammaplasty . J Psychosom Res . 1990;;34:509-514.
9 +
Evans RD, Ryan JJ.  Reduction mammaplasty for the teenage patient: a critical analysis . Aesthetic Plast Surg . 1994;;18:291-297.
10 +
Hollyman JA, Lacey JH, Whitfield PJ, Wilson JSP.  Surgery for the psyche: a longitudinal study of women undergoing reduction mammaplasty . Br J Plast Surg . 1986;;39:222-224.
11 +
Serletti JM, Reading G, Caldwell E, Wray RC.  Long-term patient satisfaction following reduction mammaplasty . Ann Plast Surg . 1992;;28:363-365.
12 +
Raispis T, Zehrin RD, Downey DL.  Long-term fuctional results after reduction mammaplasty . Ann Plast Surg . 1995;;34:113-116.
13 +
Goin JM, Goin MK.  Reduction mammaplasty . In Changing the Body: Psychological Effects of Plastic Surgery . Baltimore, Md: Williams & Wilkins; 1981;: 203-209.
14 +
Trebitsch J.  Le corps et ses transformations comme objets d'investissement narcissique dans l'evolution d'une nevrose d'adolescente . Acta Psychiatr Belg . 1971;;71:488-496.
15 +
Goin MK.  Psychological reactions to surgery of the breast . Clin Plast Surg . 1982;;9:347-354.
16 +
Goin JM, Goin MK.  Psychological aspects of aesthetic plastic surgery . In: Lewis J, ed. The Art of Aesthetic Plastic Surgery . Boston, Mass: Little, Brown & Co Inc; 1989;:39-47.
17 +
Hoffman A.  Reduction mammaplasty: a medicolegal hazard? Aesthetic Plast Surg . 1987;;11:113-116.
18 +
Strombeck JO.  Long term results after reduction mammaplasty . Plast Surg . 1992;;1:529-530.
19 +
Zaworski RE.  Anorexia nervosa following a pharyngeal flap operation . Cleft Palate J . 1981;;18:223-224.
20 +
Brown DM, Young VL.  Reduction mammaplasty for macromastia . Aesthetic Plast Surg . 1993;;17:211-223.
21 +
Gifford S.  Cosmetic surgery and personality change: a review and some clinical observations . In: Goldwyn RM, ed. The Unfavorable Result in Plastic Surgery: Avoidance and Treatment . Boston, Mass: Little, Brown & Co Inc; 1984;: 21-45.
22 +
McKissock PK.  Complications and undesirable results with reduction mammaplasty . In: Goldwyn RM, ed. The Unfavorable Result in Plastic Surgery: Avoidance and Treatment . Boston, Mass: Little, Brown & Co Inc; 1984;:739-759.
23 +
Schnur PL, Hoehn JG, Ilstrup DM, Cahoy MJ, Chu CP.  Reduction mammaplasty: cosmetic or reconstructive procedure? Ann Plast Surg . 1991;;27:232-237.
24 +
Miller AP, Zacher JB, Berggren RB, Falcone RE, Monk J.  Breast reduction for symptomatic macromastia: can objective predictors of operative success be identified? Plast Reconstr Surg . 1995;;95:77-83.
25 +
Davis GM, Ringler SL, Short K, Sherrick D, Bengston BP.  Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction . Plast Reconstr Surg . 1995;;96:1106-1110.
26 +
Little JW III, Spear SL, Romm S.  Reduction mammaplasty and mastopexy . In: Smith JW, Aston SJ, eds. Grabb and Smith's Plastic Surgery . Boston, Mass: Little, Brown & Co Inc; 1991;:1157-1202.

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