title: The health burden of breast hypertrophy.
abstract: Women seeking consultation for the surgical relief of symptoms associated with breast hypertrophy have been the focus of many studies. In contrast, little is known about those women with breast hypertrophy who do not seek symptomatic relief. The purpose of this study was to describe the health burden of breast hypertrophy by using a set of validated questionnaires and to compare women with breast hypertrophy who seek surgical treatment with those who do not. In addition, this latter group was compared with a group of control women without breast hypertrophy. Women seeking consultation for surgery were recruited from 14 plastic-surgery practices. Control subjects were recruited by advertisements in primary-care offices and newspapers. Women were asked to complete a self-report questionnaire that included the European Quality of Life (EuroQol) questionnaire, McGill Pain Questionnaire, Multidimensional Body Self Relations Questionnaire (MBSRQ), the Short Form-36 (SF-36) questionnaire, and questions regarding breast-related symptoms, comorbidities, and bra size. Descriptive statistics were compiled for three groups of women: (1) hypertrophy patients seeking surgical care, (2) hypertrophy control subjects (those whose reported bra-cup size was a D or larger), and (3) normal control subjects (those whose reported bra-cup size was an A, B, or C). The multiple linear regression method was used to compare the health burdens across groups while adjusting for other variables. Two hundred ninety-one women seeking surgical care and 195 control subjects were enrolled in the study. The 184 control subjects with bra-cup information available were further separated into 88 hypertrophy control subjects and 96 normal control subjects. In the control group, bra-cup size was correlated with health-burden measures, whereas in the surgical candidates, it was not. When scores were compared across the three groups, significant differences were found in all health-burden measures. The surgical candidates scored more poorly on the EuroQol utility, McGill pain rating index, MBSRQ appearance evaluation, physical component scale of the SF-36, and on breast symptoms than did the two control groups. In addition, the hypertrophy control subjects scored more poorly than the normal control subjects. With multiple linear regression analysis incorporating important potential confounders, the poorer scores in the surgical candidates remained statistically significant. It was concluded that breast hypertrophy in those seeking surgical care and those not seeking surgery has a significant impact on women's quality of life as measured by validated and widely used self-report instruments including the EuroQol, MBSRQ, McGill Pain Questionnaire, and the SF-36. Likewise, a new assessment instrument for breast-related symptoms also demonstrated greater symptomatology in women with breast hypertrophy.
authors.affiliation: Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, NH 03756, USA. carolyn.l.kerrigan@hitchcock.org
authors.forename: C L
authors.initials: CL
authors.lastname: Kerrigan
authors.forename: E D
authors.initials: ED
authors.lastname: Collins
authors.forename: D
authors.initials: D
authors.lastname: Striplin
authors.forename: H M
authors.initials: HM
authors.lastname: Kim
authors.forename: E
authors.initials: E
authors.lastname: Wilkins
authors.forename: B
authors.initials: B
authors.lastname: Cunningham
authors.forename: J
authors.initials: J
authors.lastname: Lowery
mesh_terms: D000328:Adult; D001828:Body Image; D001940:Breast / Q000473:pathology*; D005260:Female; D006304:Health Status; D006801:Humans; D006984:Hypertrophy / Q000523:psychology / Q000601:surgery; D016462:Mammaplasty / Q000523:psychology; D010146:Pain; D011788:Quality of Life; D011795:Surveys and Questionnaires