Effects of reduction mammoplasty on upper-limb nerve conduction across the thoracic outlet in women with macromastia: a prospective randomized study.

Abstract

Macromastia is a common problem. The physical complaints include upper body pain and aches. There have been anecdotal reports of neurologic deficits in the nerves emanating from the lower trunk of the brachial plexus. This is thought to be due to pressure on the lower trunk from both the first rib and tilting forward of the coracoid process. Other anecdotal reports have centered on the correction of neuropraxia of the ulnar nerve following bilateral breast reduction (BBR). We investigate the effect of BBR on the electrophysiological function of the nerve supply to the upper limbs in women with macromastia. Consecutive patients undergoing BBR were randomized into 2 groups, depending on time of surgery. None had any prior neurologic disorder. Each patient had a comprehensive neurologic assessment and 2 electrodiagnostic neurophysiologic tests. Group 1 had 2 tests, one before surgery and a second 3 months postsurgery, while Group 2 had 2 sets of tests, one initially and a second test 4 months later (control). The outcome measures include somatosensory evoked potential (SSEP) (median and ulnar), F-wave median and ulnar latencies. The F waves measure the integrity of neural conduction time from the anterior horn cells to the hypothenar and thenar muscles reflecting lower trunk function. The SSEP of the median nerve measure the integrity of the nerve fibers traversing the upper trunk of the brachial plexus and the ulnar nerve SSEP that of the lower trunk. There was no statistical difference in the conduction times. BBR does not have any effect on the upper limb nerve conduction times.