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.

Takeaways

Question: This systematic review and meta-analysis pool available data on postoperative complications and recurrence rates after reduction mammoplasty for juvenile gigantomastia.

Findings: The pooled postoperative complications and recurrence rates were 17.5% and 15.6%, respectively. A random-effects model was used to account for the substantial heterogeneity in study populations, methodologies, and settings. The results indicate the potential for symptom persistence or reemergence after surgery.

Meaning: The results highlight the importance of long-term follow-up in adolescents undergoing breast reduction for gigantomastia, and the need for consistent surgical and reporting practices to provide more reliable estimates and to guide clinical care.

INTRODUCTION

Juvenile macromastia, also known as virginal mammary hypertrophy, is a noncancerous breast disorder primarily affecting female adolescents who experience significant and abnormal enlargement of 1 or both breasts. In more severe cases, it is termed gigantomastia.^1,2 Reduction mammoplasty is considered a safe and effective treatment for alleviating physical symptoms, including headaches, backaches, and shoulder pain, associated with extreme breast size. Poor psychological well-being (such as depression, anxiety, and eating disorders) has also been reported in adolescents diagnosed with juvenile macromastia when compared with their unaffected peers,³ which is alleviated by reduction mammoplasty.⁴

However, the possible risks and complications of reduction mammoplasty, such as altered breast or nipple sensation, future breastfeeding difficulties, and massive breast regrowth, remain concerns.⁵ Investigations of reduction mammoplasty outcomes have primarily focused on adults. Previous studies on adolescent patients diagnosed with macromastia have consistently affirmed the safety and effectiveness of breast reduction procedures in this population; nevertheless, the existing body of research remains limited.^6,7 Previous studies have primarily focused on patient satisfaction. However, these investigations were limited by small sample sizes and did not evaluate aesthetic outcomes or direct comparisons between various incision patterns. Thus, despite its benefits, reduction mammoplasty in adolescents remains controversial due to the limited data available on short-term and long-term surgical complications in this age group.^4,8–10 Consequently, some surgeons hesitate to perform this surgery on adolescents, resulting in delays in referrals and surgery until adulthood, irrespective of the patient’s psychological and developmental maturity.^8,11

Studies in adults have identified risk factors associated with complications, including age, obesity, smoking, and breathing difficulties.¹² However, many of these factors do not apply to the pediatric population. Current research indicates that most patients undergoing reduction mammoplasty are overweight, which can impact wound healing. Nevertheless, data on the pediatric population are limited.^13,14 Thus, we set out to conduct a thorough and comprehensive review of existing literature focusing on postoperative complications, recurrence, long-term sequelae, and overall patient satisfaction rate among adolescents who have undergone bilateral breast reduction surgery to treat juvenile macromastia and gigantomastia.

METHODS

Literature Search Strategy

We searched the MEDLINE, Google Scholar, Web of Science, and Embase databases for relevant articles, using the keywords (“juvenile macromastia”) OR (“juvenile gigantomastia”) OR (“pediatric macromastia”) OR (“Pseudoangiomatous stromal hyperplasia”) AND (“breast reduction”) OR (“reduction mammaplasty”), from database inception to November 2023.

Study Selection Criteria

Four primary reviewers were divided into 2 equal groups, and a fifth reviewer resolved conflicts. We included English-language studies presenting raw numbers of the complications and outcomes, whose participants were women diagnosed with juvenile macromastia before the age of 21 years, who underwent breast reduction surgery, and which reported results of clinical interest. We included original research reports, that is, cohort studies, retrospective studies, and randomized clinical trials, but excluded meta-analyses/systematic reviews, economic analyses, animal studies, cadaveric studies, narrative reviews, case reports, case series, and editorials. Additionally, studies on other forms of macromastia or gigantomastia, for example, gestational gigantomastia, and articles that did not report outcomes of interest, were excluded.

Quality Assessment and Level of Evidence

We used the Methodological Index For Non-Randomized Studies (MINORS) to evaluate the effectiveness of the included studies.¹⁵ This tool features 8 criteria for noncomparative research and 12 criteria for comparative studies, with each criterion being scored between 0 and 2. Noncomparative studies can score up to 16 points, whereas comparative studies can score up to 24 points. Two authors used the MINORS independently to evaluate the quality of the included studies. Any disagreements were resolved by discussion or by consulting a third author.

Reporting

To ensure thorough and transparent reporting, this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines (Fig. 1).

Fig. 1.

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

Data Extraction

We extracted data on postoperative complications, including nipple necrosis, hematoma, infection, deep vein thrombosis, wound dehiscence, seroma, altered nipple sensation, scarring, and recurrence. Secondary outcomes assessed comprised patient satisfaction, resolution of preoperative symptoms, postoperative lactation ability, follow-up duration, and overall outcomes. Additionally, data on patient demographics, such as age, body mass index (BMI), and comorbidities, were collected where reported to facilitate subgroup analyses.

Data Analysis

Statistical analysis was performed with IBM Statistical Package for the Social Sciences version 27 software (IBM Corp., Armonk, NY). Simple descriptive statistics were used to present study variables (counts and percentages for categorical variables; mean and SDs for continuous variables). For the meta-analysis, we used the Comprehensive Meta-Analysis version 4 software (Englewood, NJ).¹⁶ We performed single-group meta-analyses, as the included studies did not include comparison groups. A pooled analysis was performed for the main findings: postoperative complications and recurrence. The analysis output was a point estimate of the corresponding complication rate, with confidence intervals (CIs). We used random-effects models, with a P value less than 0.05 indicating statistical significance. Heterogeneity across the studies was assessed using the I² statistic, which quantifies the percentage of variation across studies due to heterogeneity rather than chance. An I² value greater than 50% was considered indicative of substantial heterogeneity. In cases of high heterogeneity (I² > 75%), a random-effects model was used to account for between-study variability and improve the generalizability of the findings. Publication bias was assessed using funnel plots to visually evaluate symmetry, where asymmetry suggested potential bias.

RESULTS

Characteristics of the Included Studies

This systematic review included 11 studies, all of which were retrospective or prospective cohort studies conducted in the United States and the United Kingdom that examined the outcomes of bilateral breast reduction surgery for juvenile macromastia. Sample sizes ranged from 34 to 1345 patients, with mean ages between 16.5 and 18.3 years. (See table, Supplemental Digital Content 1, which displays the general characteristics of the included studies, https://links.lww.com/PRSGO/E174.) The follow-up periods varied widely, with some studies reporting short-term follow-ups, such as Tapp et al¹⁰ with a mean follow-up period of 6.3 months, whereas other studies, including Nuzzi et al,¹⁷ had a median follow-up period of 19.1 months.

Risk of Bias Assessment

The MINORS total scores of the studies ranged from 4 to 10 points, with most studies scoring below 7 points (Tables 1, 2). The items that received low scores consistently were the prospective calculation of study size and prospective data collection, both of which scored 0 in almost all studies. Furthermore, the inclusion of consecutive patients and unbiased assessment of the study endpoint were weak points, with most studies scoring 0 or 1. The highest scoring items across the majority of the studies were a clearly stated aim and endpoints appropriate to the aim of the study, which scored 2 points in all studies. This pattern indicated a general strength in clear objectives and endpoints, but noteworthy weaknesses in study design and potential biases in data collection and analysis.

Table 1.

MINORS Criteria of Nonrandomized Noncomparative Studies

Items	Tapp et al10	Xue et al7	Soleimani et al8	Morrison et al4	Nuzzi et al17	Koltz et al18	Webb et al19	Payne et al13	Fairchild et al9	Nuzzi et al5
A clearly stated aim	2	2	2	2	2	2	2	2	2	2
Inclusion of consecutive patients	0	0	0	2	0	2	0	0	0	0
Prospective collection of data	0	0	0	0	0	0	0	0	0	2
Endpoints appropriate to the aim of the study	2	2	2	2	2	2	2	2	2	2
Unbiased assessment of the study endpoint	1	1	0	1	0	0	0	0	1	1
Follow-up period appropriate to the aim of the study	1	0	0	0	0	0	0	0	N/A	2
Loss to follow-up less than 5%	0	0	N/A	0	0	0	0	0	N/A	0
Prospective calculation of the study size	0	0	0	0	0	0	0	0	0	0
Total score	6	5	4	7	4	6	4	4	5	9

N/A, not applicable.

Table 2.

MINORS Criteria of Nonrandomized Comparative Studies

MINORS Instrument Assessment for Nonrandomized Comparative Studies (N = 1)
Items	Kulkarni et al11
A clearly stated aim	2
Inclusion of consecutive patients	0
Prospective collection of data	0
Endpoints appropriate to the aim of the study	2
Unbiased assessment of the study endpoint	1
Follow-up period appropriate to the aim of the study	0
Loss to follow-up less than 5%	0
Prospective calculation of the study size	0
An adequate control group	2
Contemporary groups	0
Baseline equivalence of groups	1

Main Outcomes Across the Included Studies

Overall, the studies consistently concluded that breast reduction surgery in adolescents with macromastia was highly effective in alleviating physical symptoms and improving patient satisfaction. Patient satisfaction was evaluated in 4 studies. High satisfaction rates were reported, with Tapp et al¹⁰ and Xue et al⁷ demonstrating a 98% and 97% patient satisfaction rate; Fairchild et al⁹ reported a mean BREAST-Q satisfaction score of 74%, whereas Kulkarni et al¹¹ found that 72% of patients were satisfied.

Recurrence rates of macromastia varied, with Nuzzi et al¹⁷ reporting a high rate of 52.9%, whereas Xue et al⁷ and Morrison et al⁴ reported none. Several studies, including Xue et al⁷ and Nuzzi et al,⁵ emphasized the safety and efficacy of the procedure, particularly when performed by a multidisciplinary team. However, rates varied for the main outcome of postoperative complications. Soleimani et al⁸ found that postoperative complication rates were as low as 3.1%, whereas Tapp et al¹⁰ reported that 39.2% of patients experienced complications (Table 3).

Table 3.

General Complication Rates Associated With Breast Reduction Surgery in Adolescents With Juvenile Macromastia

Study	Reported Comorbidities	Total Patients, n	Total Complications, %	Recurrence, %
Tapp et al10	Obesity	51	39.2	9.80
Xue et al7)	Systemic lupus erythematosus	34	17.6	0.00
Nuzzi et al5	NM	512	25.6	23.53
Soleimani et al8	Chronic pulmonary disease, obesity, fluid and electrolyte disorders, iron deficiency, and tobacco use	1345	3.1	—
Morrison et al4	Diabetes mellitus and smoking	80	33.8	0.00
Nuzzi et al17	Overweight and obesity	481	5.6	52.94
Kulkarni et al11	Overweight, obesity, and smoking	60	28.3	1.96
Koltz et al18	Obesity	76	11.8	0.00
Webb et al19	Overweight and obesity	67	34.3	—
Payne et al13	NM	41	31.7	—
Fairchild et al9	Obesity	542	6.8	35.29

NM, not mentioned.

The types of complications are summarized in Table 4. Wound dehiscence rates were substantially high in several studies, such as those of Nuzzi et al⁵ (39.2%) and Webb et al¹⁹ (37.3%). Hematoma rates were highest in the studies of Tapp et al¹⁰ and Soleimani et al⁸ (29.4%), whereas Xue et al⁷ and Nuzzi et al¹⁷ reported no hematomas. Postoperative infection rates were relatively low across the included studies, with Fairchild et al⁹ reporting the highest rate (27.5%). Regarding more severe complications, nipple necrosis was rare, at only 2.0% in 4 included studies.^4,5,11,18 Altered nipple sensation was observed in 56.9% and 25.5% of patients in the studies of Nuzzi et al⁵ and Webb et al,¹⁹ respectively. Other complications, such as seroma and scarring, were sporadically reported, with Nuzzi et al⁵ reporting the highest scarring rate (88.2%).

Table 4.

Detailed Complications Associated With Breast Reduction Surgery in Adolescents With Juvenile Macromastia Across the Included Studies

Study	N	Wound Dehiscence, %	Hematoma, %	Infection, %	Seroma, %	Nipple Necrosis, %	DVT, %	Scarring, %	Altered Sensation of the Nipple, %
Tapp et al10	51	29.4	29.4	29.4	29.4	0.0	—	9.8	0.0
Xue et al7	34	5.9	0.0	2.0	0.0	0.0	—	3.9	0.0
Nuzzi et al5	512	39.2	23.5	23.5	23.5	2.0	0.0	88.2	56.9
Soleimani et al8	1345	0.0	29.4	2.0	29.4	0.0	0.0	0.0	0.0
Morrison et al4	80	17.7	2.0	0.0	5.9	2.0	0.0	25.5	0.0
Nuzzi et al17	481	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0
Kulkarni et al11	60	25.5	0.0	2.0	0.0	2.0	—	2.0	0.0
Koltz et al18	76	7.8	0.0	3.9	5.9	2.0	—	—	—
Webb et al19	67	37.3	2.0	3.9	0.0	0.0	—	13.7	25.5
Payne et al13	41	—	2.0	5.9	—	—	—	—	—
Fairchild et al9	542	7.8	—	27.5	—	—	0.0	—	—

DVT, deep vein thrombosis.

Several studies included comorbidities and risk factors, including obesity, diabetes, and smoking, which might contribute to higher complication rates. None of the included studies provided detailed assessments of postoperative lactation or the potential for breast growth after surgery. However, Webb et al¹⁹ emphasized that surgical readiness should be determined on a case-by-case basis, considering the patient’s characteristics (Supplemental Digital Content 1, https://links.lww.com/PRSGO/E174).

Meta-analysis Findings

Postoperative Complications

Figure 2 and Table 5 show the output of the random-effects model of the analysis, along with heterogeneity measures. Given the high heterogeneity across studies (I² = 97%), which could reflect statistical, methodological, and population heterogeneity, the pooled postoperative complications rate was 17.5%, with a 95% CI of 9.7%–29.5% (P < 0.001).

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.

Table 5.

The Output of the Meta-analysis of All Complications Associated With Breast Reduction Surgery in Adolescents With Juvenile Macromastia

Model	Effect Size and 95% CI			Prediction Interval			Between Study		Other Heterogeneity Statistics
	No. Studies	Point Estimate	Lower Limit	Upper Limit	Lower Limit	Upper Limit	τ	τ2	Q	df (Q)	P	I 2
Fixed	11	0.153	0.138	0.169					292.986	10	0.000	96.587
Random	11	0.175	0.097	0.265	0.015	0.749	1.117	1.248

Regarding the assessment of publication bias, the present meta-analysis integrated data from 11 studies. A funnel plot of postoperative complications displayed a scattered pattern, indicating a low risk of publication bias (Fig. 3).

Fig. 3.

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

Recurrence

Figure 4 and Table 6 show the output of the random-effects model for the pooled rate of postoperative recurrence: 15.6% (95% CI: 8.5%–26.9%), with a heterogeneity measure of I² equal to 95.1%. The funnel plot probing publication bias also showed asymmetry, with points focused in the upper middle and lower left part of the funnel, indicating a potential risk of publication bias (Fig. 5).

Fig. 4.

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

Table 6.

The Output of the Meta-analysis of the Recurrence Associated With Breast Reduction Surgery in Adolescents With Juvenile Macromastia

Model	Effect Size and 95% CI			Prediction Interval			Between Study		Other Heterogeneity Statistics
	No. Studies	Point Estimate	Lower Limit	Upper Limit	Lower Limit	Upper Limit	τ	τ2	Q	df (Q)	P	I 2
Fixed	8	0.364	0.340	0.389					142.877	7	0.000	95.101
Random	8	0.156	0.085	0.269	0.023	0.593	0.767	0.588

Fig. 5.

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

DISCUSSION

This study analyzed 3289 adolescent patients who underwent breast reduction surgery. All included studies derived from the United States and the United Kingdom. Based on random-effects models due to study heterogeneity, we found an overall pooled postoperative complication rate of 17.5% (95% CI: 9.7%–29.5%) and a recurrence rate of 15.6% (95% CI: 8.5%–26.9%), ranging from 0% to 52.9%.

Postoperative Complications

Various postoperative complications were reported across the studies. Nevertheless, patient satisfaction rates were high, with a rate of 97% reported by Xue et al.⁷

Wound dehiscence was reported in 10 of the 11 studies, with an incidence ranging from 7.84%¹⁸ to 39.22%.⁵ This is possibly linked to surgical technique, patient health, and postoperative care. Hajebian et al²⁰ reported that wound dehiscence at the T junction occurred in 4.1% of the adolescent group versus 8.7% of the average-age group, and wound dehiscence (exceeding 3 cm) was related to surgical site infection in 10 of 912 patients.

Hematoma formation also occurred in 10 of the 11 studies, with the incidence ranging from 0%¹⁰ to 29.41%.⁶ The discrepancy in hematoma incidence may reflect the underreporting of both the frequency and severity of hematoma, possibly because hematomas are treated immediately in the operative room or in the outpatient department during follow-up.

Postoperative wound infection rates varied across the studies from 1.96%⁷ to 27.45%.⁹ These low infection rates are likely due to the advances in perioperative and postoperative care, and prompt treatment with antibiotics.

Seroma formation and nipple necrosis were reported in only 9 studies. Seroma incidence ranged from 0%¹³ to 23.53%.⁵ Nipple necrosis did not occur in 2 studies, whereas the highest incidence was reported by Nuzzi et al¹⁷ at 1.96%. Hajebian et al²⁰ reported no nipple necrosis in their adolescent group, although necrosis occurred within 1 month postoperatively in 3 adolescent patients (3.3%), requiring excision.

Scarring was observed in 8 studies, with an incidence ranging from 7.84%⁹ to 88.24%.⁵ These high statistics imply the need to consider the surgical technique to minimize this outcome, given that this also impacts overall patient satisfaction. Surgical approaches in the included studies encompassed reduction mammaplasty using an inferior pedicle, reported in 3 studies (27.3%); reduction mammoplasty with superomedial pedicles, reported in 1 study (9.1%); reduction mammoplasties with unspecified techniques, reported in 3 studies (27.3%); and use of medial or inferior pedicles, reported in 1 study (9.1%). Morrison et al⁴ quantified surgical complications for reduction mammaplasty in 80 patients (15–20 y old) and found that wound healing and scarring were not affected by skin incision type, pedicle use, or weight of breast reduction. Thus, scarring may be attributed to the surgeon and the incision technique used.

Altered nipple sensation was reported in 8 studies, with an incidence ranging from 0%⁶ to 56.9%.⁵ As altered nipple sensation is mainly subjective, the difference across studies may be attributed to patients’ responses to the nipple sensation assessment, lack of reporting by patients, or the late development of altered nipple sensation. La Padula et al²¹ reported that, in their sample of 912 patients who underwent superomedial-posterior pedicle-based reduction mammaplasty, only 61 events of complications occurred. Over its 2-year follow-up period, altered nipple sensation was restored in all patients, implying that this sensation requires a long-term follow-up, as it may be a temporary phenomenon.

Recurrence

Three studies did not report on breast enlargement recurrence, whereas recurrence rates varied across the remaining 8 studies, from 0%⁴ to 52.9%.¹⁷ A study by Baker et al¹ reported that in 4 cases, 2 patients (aged 10 and 12 y) treated without reduction required a secondary procedure. One patient underwent subtotal reduction, but required 2 subsequent operations due to recurrence (likely due to gigantomastia); however, the studies analyzed did not classify their patients as having either macromastia or gigantomastia, and caution should be taken when considering performing such procedures, as recurrence is likely to occur. In another case, a gravid 24-year-old previously treated for juvenile macromastia presented with gestation-induced recurrent breast hypertrophy. The fourth patient, who was 17 years old, did not require further reduction. This finding is significant due to the high recurrence of hypertrophy in patients treated at younger than at older ages,¹ and highlights possible recurrence due to gestation and severe forms of macromastia. In a systematic review of 23 studies (87% retrospective), including 2926 patients, by Cruz and Korchin,²² 18% of patients (95% CI: 2.2%–43.8%) reported postoperative regrowth of breast tissue, with 2.7% (95% CI: 0.9%–5.5%) undergoing revision mammoplasty. This highlights the importance of follow-up and patient education on the possibility of regrowth and a second mammoplasty procedure.²³

Patient-related Factors

Only a few articles reported the effects of the surgery on the physical and psychosocial well-being of the same patients. Evaluation of patient satisfaction and the psychological impact should be addressed in future studies, particularly given the crucial developmental stage of this age group. Only 2 of the included studies reported that patients with obesity experienced greater improvement in psychosocial well-being, with an overall high success rate following the procedure.^10,13

Payne et al¹³ demonstrated that satisfaction rates significantly improved post reduction mammoplasty (24.1% versus 92.6%), particularly in patients with a higher BMI (29.6 versus 43.3 kg/m²). Cerrato et al²³ reported that the impact of macromastia was mostly independent of the BMI category. According to Koltz et al,¹⁸ adolescent mammoplasty patients present symptoms mirroring those of the adult population, but also exhibit greater obesity, physical strain, social distress, and comorbid psychiatric disorders. They found similar complication rates in adults to those found in the adolescent population of our review.

Some of the included studies took patient BMI into consideration. Webb et al¹⁹ reported that significantly more complications were found among patients with obesity than among those without. However, the type of complication or self-reported satisfaction did not differ according to obesity by 34.4 ± 25.7 weeks postsurgery. These findings imply that obesity is not an absolute contraindication to reduction mammaplasty in adolescents.¹⁹

Strengths and Limitations

Most included studies were retrospective, which has inherent limitations, such as recall bias and incomplete data. Moreover, the quality of these studies varied from poor to fair, with a notable lack of higher quality studies. Consequently, with relatively low evidence levels of each study, our study’s findings should be considered cautiously. This highlights the need for further higher quality studies following standardized protocols.

The included studies did not exclusively focus on gigantomastia but rather on macromastia or breast hypertrophy in adolescents, which may not meet the criteria for true gigantomastia. Although this may introduce some heterogeneity, the studies were included because they involved patients with significant breast enlargement. Future studies should aim to more clearly distinguish between macromastia and gigantomastia for a more focused analysis.

The asymmetry observed in the funnel plot for recurrence data raises concerns about potential publication bias and the influence of outlier studies. Notably, the inclusion of a large study with 1345 patients may have disproportionately impacted symmetry, creating a bias that could reflect study size variation rather than true publication bias. Furthermore, the heterogeneity across studies, including differences in follow-up duration and recurrence definitions, may have compounded this effect. Although this highlights the need for careful interpretation, the overall trends observed for postoperative complications remained consistent and generalizable. Future research should focus on standardizing outcome measures and incorporating formal statistical tests to assess bias more rigorously.

Adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines strengthens our study’s foundation and the validity of our findings. The comprehensive nature of our study and systematic methodology, along with the employment of a rigorous statistical approach, strengthened our findings. Furthermore, the findings may not be applicable to the global population, requiring future research to be conducted on a broader demographic range.

Healthcare providers should be aware of the negative health outcomes that are associated with macromastia and should consider early evaluation for adolescents with this condition.¹² Surgeons should strongly consider reduction mammaplasty in carefully selected adolescents with macromastia, with realistic expectations and understanding of the complications in this group.

CONCLUSIONS

This study compared data on postoperative complications and recurrence rates following reduction mammoplasties in adolescents with juvenile macromastia. The pooled rate of postoperative complications was 17.5%. There was variability across studies, emphasizing the need for consistent surgical and reporting practices. A random-effects model was used to account for the substantial heterogeneity in study populations, methodologies, and settings. The recurrence rate was estimated at 15.6%, indicating the potential for symptom persistence or reemergence after surgery. These findings highlight the importance of long-term follow-up and standardized reporting in future research to provide more reliable estimates and to guide clinical care for adolescents with macromastia.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

ACKNOWLEDGMENT

The authors would like to thank Mr. Kalvin M. Balucanag for his assistance and support in the statistical analysis process, as well as Faisal M. Alrashdan for his unwavering support and encouragement throughout the course of this study.