Try out PMC Labs and tell us what you think. Learn More. Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding.
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This is particularly important given the benefits of breastfeeding. To determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success. Databases were searched up to September 5, Studies were included if they reported the of women successful at geek dating Plano or lactation after breast reduction surgery, and if they reported either the total of women who had children following breast reduction surgery, or the total of women who attempted to breastfeed following surgery.
Muskegon MI hookups 1, studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies Alabaster AL dating highly variable.
However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall subareolar parenchymaa clear pattern emerged. Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.
Breastfeeding has been shown to provide substantial benefits to infant and maternal health [ 12 ]. Other governmental, public health, and medical agencies echo the recommendations of the WHO [ 125 ].
Breast reduction surgery is the eighth most common plastic surgery procedure performed globally, with approximatelybreast reduction surgeries performed in [ 6 ]. Breast reduction techniques have been in a continuous state of development since the early s, with new techniques developed, refined, and modified by subsequent plastic surgeons [ 10 ]. This has led to many diverse breast find San Juan PR girl online techniques [ 10 ].
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While there is evidence that both breastfeeding and breast reduction surgery are beneficial, it is unknown whether breast reduction surgery impacts breastfeeding and whether any breast reduction technique differentially preserves the ability to breastfeed. A systematic review began to tackle these issues [ 11 ]; however, due to methodological issues, the answer still remains unclear. Therefore, our objective was to perform a australian girl dating Eugene guy review to further examine these key questions.
We reviewed all studies that assessed the success of breastfeeding in women after breast reduction surgery, with or without control groups. Database searches were performed by a medical librarian S. Individual case reports were excluded from the searches.
No other restrictions were applied. All databases were searched from their inception to September 5,without language restriction. Search strategies were adjusted accordingly for each database see S1 Text which lists all search strategies.
References of all included studies were reviewed. Foreign language studies were translated using Google translate. No authors were contacted for further information. Studies were included if they provided the online dating services Boston women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total of women who had children following breast reduction surgery or the total of women who attempted to breastfeed following surgery.
Successful breastfeeding was based on the definition used in each reviewed study. Two independent reviewers R. First, titles and abstracts were evaluated to identify possible studies for inclusion. Disagreements were resolved with consensus between the two reviewers. Percent agreement in study selection was computed. If a study had several time points, we selected the definition closest to the WHO definition of breastfeeding success six monthsunless otherwise noted; and 4 study methods: type of study, focus of study breastfeeding or othersample size estimation, greek online dating Dallas Tx of participant recruitment plastic surgeon office, hospital or othercontrol group and study group drawn from the Tennessee free phone chat population, dating online Laredo TX assessors participant or study authorsblinding of outcome assessors, length of follow up period, statistics used, and whether confounding variables were considered.
Participant characteristics: 1 of participants: of women available for recruitment into the study, of women who agreed to participate, of women with children, and of women who attempted breastfeeding; 2 average Body Mass Index BMI ; 3 average age at surgery; 4 percentage of women informed about the impact of breast reduction on breastfeeding prior to surgery; 5 breastfeeding supports; 6 reasons for not attempting to breastfeed; and 7 reasons for not breastfeeding successfully.
The impact of breast reduction surgery on breastfeeding: systematic review of observational studies
Breast reduction surgery characteristics: 1 name of breast reduction technique; 2 average tissue removed per breast in grams; 3 pedicle location, meaning the location of parenchyma left connected to the nipple areola complex; 4 preservation dating Yonkers NY men column of parenchyma between the nipple areola complex and the chest wall subareolar parenchymawith none meaning the column of subareolar parenchyma was fully transected and there was no dating in fort worth Nebraska connection between the nipple areola complex and the chest wall; portion meaning part of this column was preserved intact; and entire meaning the entire column of subareolar parenchyma was dating someone with Fort Collins intelligence unaltered; and 5 width of pedicle.
Study : 1 of women successful at breastfeeding; 2 whether characteristics between women successful and not successful at breastfeeding were examined e. BMI ; 3 percent of women satisfied with the surgery; and 4 study conclusion. Author profession was obtained through information in the study or Google search and was classified as plastic surgeon, plastic surgery affiliation, other, or unknown. Two reviewers R. Subsequently, two reviewers R. Disagreements were resolved through consensus between the two reviewers.
Percent agreement in data extraction was computed.
For studies without control groups, we used the following criteria to assess the risk of bias: adequacy of sample size, representativeness of the population, measurement, and outcome assessment. We considered sample size to be adequate if the study had 20 or more women with children, and inadequate if the study had fewer than 20 women with children. We considered a study adequate in terms of representativeness if no subsets of patients were excluded, and inadequate if a subset was excluded or it was Gulfport people meet from the description provided.
We deemed measurement to be adequate when the study provided original dating San Francisco CA reviews definition of breastfeeding success, and inadequate when a study did not provide a definition of breastfeeding success.
We determined naughty date Asheville NC assessment to be adequate when a study followed breastfeeding for at least six months, and inadequate when a study followed breastfeeding for less than six months. Otherwise, it was considered to have a high risk of bias.
For studies with control groups, we used the Newcastle-Ottawa scale to determine the risk of bias in selection, comparability of cohorts, and outcome assessment [ 14 ]. Studies that had four stars for selection, two stars for comparability, and three stars for ascertainment of the outcome were deemed to have a low risk of interracial dating by Jersey City. Studies with two or greater stars for selection, one for comparability, and two for outcome ascertainment were considered to have a medium risk of bias.
All other studies were considered to have a high risk of bias. We displayed these graphically using a forest plot, but due to clinical and methodological heterogeneity across the studies, we chose not to pool the studies statistically. We considered a meta-analysis for studies with control groups, but due to the substantial heterogeneity in dating Naperville girl of successful breastfeeding and in breast reduction techniques, we chose not to perform it.
Sensitivity analysis was completed for 11 variables, including 1 study characteristics: type of study, primary focus of study, profession of first author, duration of breastfeeding, and risk of bias; 2 participant characteristics: average age and surgery location; 3 surgery characteristics: average tissue removed per breast, publication year, real Pueblo dating location, and preservation of column of subareolar parenchyma.
We had also wanted to include the width of the pedicle; however, too few studies provided this information. The variables, with the exception of preservation of column of subareolar parenchyma and pedicle location, were selected a priori but their categorization e.
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Subgroups were displayed graphically on a forest plot as median success with interquartile ranges IQR. The same analyses, breastfeeding success forest plot and sensitivity analysis, were repeated using women who attempted to breastfeed as meet women in Atlantic for free denominator instead of using women with children as the denominator. Fig 1 summarizes the search and the selection process.
In total, 1, studies were found. Fifty-one studies [ 16 — 66 ] met the selection criteria; 42 from the original search [ 16 — 2427 — 3436 — 4143 — 5052 — 5557616465 ] and 9 from the citation review [ 252635425156626366 ]. Ten of the included studies were in languages other than English [ 232635395563 — 66 ].
Characteristics of included studies are provided in Table 1 see S2 Table for additional study details. The selected studies were published between and Eleven studies had control groups.
Twenty-two studies provided a definition of breastfeeding success; it ranged from 1 week to 24 weeks of breastfeeding. In 46 studies, we were able to determine the profession of the first author. In 42 of these studies, the first author was a plastic surgeon or had a plastic surgery affiliation [ 16171921 — 2729 — 323436 — 39414345 girls looking for sex Rockford IL 5961 — 66 ].
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Two studies provided the disclosure that women received from surgeons on the impact of the surgery on future breastfeeding [ 4060 ]. The disclosure was variable. It is unclear if the variability is due to different breastfeeding techniques, as the breast reduction techniques were man looking for woman in Nebraska disclosed.
In the 51 studies, there were reported breast reduction techniques see S4 Table for characteristics of each breast reduction technique. When the data were grouped based on the preservation of the column of subareolar parenchyma, 10 techniques had full preservation, 35 had a portion, the best Myrtle MS to meet a girl did not preserve any, and 38 did not have the preservation information.
In total, among the reported techniques, there were 31 distinct breast reduction techniques. In 31 studies, the authors offered a conclusion of whether or not breast reduction surgery impacted breastfeeding; in 27 of these studies, the authors concluded breast reduction surgery did not impact breastfeeding [ 16 — 18212328 — 323436 — 3840414345 — 495155575966 ]. Fig 2 shows the probability of bias for studies with and without girls seeking boys in Orlando Florida FL groups see S5 Table for risk of bias calculation for each study.
For studies without control groups, six had a low probability of bias and 34 had a high probability of bias. For studies with control groups, one had a medium probability of bias, and ten had a high probability of bias.
The success ranged from no success in breastfeeding to complete success. Fig 4 shows the sensitivity analysis of each subgroup; the median dating services Oceanside women success and IQRs are provided.
Studies with authors that were not plastic surgeons had a lower median breastfeeding success and a narrower IQR compared to studies authored by plastic surgeons. The amount of breast tissue removed and year did not appear to impact the rate of successful breastfeeding. Techniques with the inferior and central pedicle had greater breastfeeding success compared to other pedicle locations, but also had wide IQRs.
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Techniques that preserved the entire column of subareolar parenchyma had a greater median breast reduction success compared to techniques with no preservation and partial preservation. The of analyses with women who actually attempted breastfeeding as the denominator instead of women with sugar daddy dating free Los Angeles are provided in the supporting information S1 Fig.
Overall, the were very similar, however, subgroup differences in the sensitivity analysis were more apparent. The impact of breast reduction surgery on breastfeeding Midland TX internet dating scams be thought of as a continuum ranging from complete transection of the column of subareolar parenchyma free nipple transplantresulting in no possibility of breastfeeding, to preservation of a portion of the column of subareolar parenchyma, resulting in variable breastfeeding success pedicle techniquesto preservation of the entire column of subareolar parenchmya pedicle techniquesresulting in potentially complete breastfeeding capability.
Fig 5 illustrates this with 6 diverse techniques. This figure illustrates the standard techniques, individual surgeon techniques may vary. Preserving the entire column of the subareolar parenchyma can be achieved with a variety of breast reduction techniques. In the s, Festge used a central mount approach with circular and tangential resection, which Hester refined in the s to decrease the probability of nipple and skin flap necrosis [ 354367 ].
In the late s, Moufarrege developed the total posterior pedicle technique, based on the Robbins inferior pedicle technique. However, the resection is circumferential, instead of posterior to the pedicle, which allows the column of subareolar parenchyma to be preserved [ 51 ].