Carpal Tunnel Syndrome in Women Undergoing Breast Reduction

  • Luis R. Pernia
  • Genelle Pernia

Women with mammary hypertrophy who present for reduction mammaplasty have several well-described musculoskeletal complaints, but a high prevalence of carpal tunnel syndrome had not been reported in the past. One hundred fifty-one patients, who underwent reduction mammaplasty from 1994 to 1996 were iden-tified from a plastic surgery practice. To this group was added a convenience sample of 64 women volunteers with relatively smaller breasts (brassiere cup size B or smaller). The entire group was questioned about spe-cific symptoms and examined using standard provocative tests. Carpal tunnel syndrome was defined as the coexistence of symptoms and at least two physical examination findings. Its association with breast size, age, race, and body mass index was examined. Stepwise logistic regression was used to determine which physical characteristics were predictive of the condition. Carpal tunnel syndrome was found in 30 patients (19.9%) (95% confidence interval, 13.8–27.1) and in none of the women in the convenience sample. Breast size and, to a lesser degree, body mass index were found to be highly significant predictors of carpal tunnel syndrome. Af er controlling for breast size, race was also significant. Breast size displayed an independent risk ratio of 6.67 when comparing the upper quartile of size to the lower quartiles. There was a markedly higher prevalence of carpal tunnel syndrome in women who presented for reduction mammaplasty than in those with smaller breasts. Breast size was a significant predictor of carpal tunnel syndrome.


Median Nerve Carpal Tunnel Syndrome Brachial Plexus Carpal Tunnel National Health Interview Survey 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Stark RB: Plastic Surgery. New York, Harper and Row 1962Google Scholar
  2. 2.
    Rees TD: Plastic surgery of the breast. In: Converse JM (ed.), Reconstructive Plastic Surgery. Philadelphia, Saunders 1964Google Scholar
  3. 3.
    Conway H: Mammaplasty: analysis of 110 consecutive cases with end-results. Plast Reconstr Surg 1952;10(3):303–315Google Scholar
  4. 4.
    Clarkson P: Appearance, cosmetic surgery and mental health. Lond Clin Med J 1965;20:37–49PubMedGoogle Scholar
  5. 5.
    Kohn F, Dalrymple J: Plastic reconstruction of the enlarged breast: report of a new technique. Br J Plast Surg 1967;20(2):184–198CrossRefPubMedGoogle Scholar
  6. 6.
    Barsky AJ, Kahn S, Simon BE: Principles and Practice of Plastic Surgery, 2nd Ed. New York, McGraw-Hill 1964Google Scholar
  7. 7.
    Maliniac JW: Breast Deformities and Their Repair. Baltimore, Waverly Press 1950Google Scholar
  8. 8.
    Kaye BL: Neurologic changes with excessively large breasts. South Med J 1972;65(2):177–180PubMedGoogle Scholar
  9. 9.
    Brown DM, Young VL: Reduction mammoplasty for mac-romastia. Aesthetic Plast Surg 1993;17(3):211–223CrossRefPubMedGoogle Scholar
  10. 10.
    Schnur PL, Schnur DP, Petty PM, Hanson TJ, Weaver AL: Reduction mammaplasty: an outcome study. Plast Reconstr Surg 1997;100(4):875–883PubMedGoogle Scholar
  11. 11.
    Ostle B, Malone LC: Statistics in Research, 4th Ed. Ames, Iowa, Iowa State University Press 1988Google Scholar
  12. 12.
    Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health, National Heart, Lung, and Blood Institute June, 1998Google Scholar
  13. 13.
    Estimates of the population of counties by race and Hispanic origin: July 1, 1997. Population Estimates Program, Population Division, U.S. Bureau of the Census. Washington, D.C. 20233Google Scholar
  14. 14.
    Dabbah A, Lehman JA Jr, Parker MG, Tantri D, Wagner DS: Reduction mammaplasty: an outcome analysis. Ann Plast Surg 1995;35(4):337–341CrossRefPubMedGoogle Scholar
  15. 15.
    Gonzalez F, Walton RL, Shafer B, Matory WE Jr, Borah GL: Reduction mammaplasty improves symptoms of macro-mastia. Plast Reconstr Surg 1993;91(7):1270–1276CrossRefPubMedGoogle Scholar
  16. 16.
    Dubuisson AS: Dept. of Neurosurgery, CHU Liege, Belgium. The Thoracic Outlet Syndrome [NerveCenter 4(2), 1999]
  17. 17.
    Pers M, Nielsen IM, Gerner N: Results following reduction mammaplasty as evaluated by the patients. Ann Plast Surg 1986;17(6):449–455CrossRefPubMedGoogle Scholar
  18. 18.
    Kinell I, Beausang-Linder M, Ohlsen L: The effect on the preoperative symptoms and the late results of Skoog's reduction mammaplasty. Scand J Plast Reconstr Surg Hand Surg 1990;24(1):61–65CrossRefPubMedGoogle Scholar
  19. 19.
    Raispis T, Zehring RD, Downey DL: Longterm functional results after reduction mammaplasty. Ann Plast Surg 1995;34(2):113–116CrossRefPubMedGoogle Scholar
  20. 20.
    McMahan JD, Wolfe JA, Cromer BA, Ruberg RL: Lasting success in teenage reduction mammaplasty. Ann Plast Surg 1995;35(3):227–231CrossRefPubMedGoogle Scholar
  21. 21.
    Muller FE: Late results of Strombeck's mammaplasty: a follow-up study of 100 patients. Plast Reconstr Surg 1974;54(6):664–666CrossRefPubMedGoogle Scholar
  22. 22.
    Bolger WE, Seyfer AE, Jackson, SM: Reduction mamma-plasty using the inferior glandular “pyramid” pedicle: experiences with 300 patients. Plast Reconstr Surg 1987;80(1):75–84CrossRefPubMedGoogle Scholar
  23. 23.
    Serletti JM, Reading G, Caldwell E, Wray RC: Long-term patient satisfaction following reduction mammoplasty. Ann Plast Surg 1992;28(4):363–365CrossRefPubMedGoogle Scholar
  24. 24.
    Davis GM, Ringler SL, Short K, Sherrick D, Bengtson BP: Reduction mammaplasty: longterm efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg 1995;96(5):1106–1110CrossRefPubMedGoogle Scholar
  25. 25.
    Shakespeare V, Cole RP: Measuring patient-based outcomes in a plastic surgery service: breast reduction surgical patients. Br J Plast Surg1997;50(4):242–248CrossRefPubMedGoogle Scholar
  26. 26.
    Rempel D, EvanoffB, Amadio PC, de Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg M, Hales T, Katz JN, Pransky G: Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998;88(10):1447–1451CrossRefPubMedGoogle Scholar
  27. 27.
    Atcheson SG, Ward JR, Lowe W: Concurrent medical disease in work-related carpal tunnel syndrome. Arch Intern Med 1998;158(14):1506–1512CrossRefPubMedGoogle Scholar
  28. 28.
    Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V: The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health 1994;84(11):1846–1848CrossRefPubMedGoogle Scholar
  29. 29.
    Letterman G, Schurter M: The effects of mammary hypertro phy on the skeletal system. Ann Plast Surg 1980;5(6):425–431CrossRefPubMedGoogle Scholar
  30. 30.
    Kendall H, Kendall F, Boynton D: Posture and Pain. Baltimore, Williams & Wilkins, 1952, pp 156–159Google Scholar
  31. 31.
    Seitchik MW: Reduction mammaplasty: criteria for insurance coverage. Plast Reconstr Surg 1995;95(6):1029–1032CrossRefPubMedGoogle Scholar
  32. 32.
    Schnur PL, Hoehn JG, Ilstrup DM, Cahoy MJ, Chu CP: Reduction mammaplasty: cosmetic or reconstructive procedure? Ann Plast Surg 1991;27(3):232–237CrossRefPubMedGoogle Scholar
  33. 33.
    Position Paper: Reduction Mammaplasty: Recommended Criteria for Third-Party Payer Coverage. Socioeconomic Committee, American Society of Plastic and Reconstructive Surgeons, June, 1994Google Scholar
  34. 34.
    Pernia LR, Ronel DN, Leeper JD, Miller HL: Carpal tunnel surgery in women undergoing reduction mammaplasty. Plast Recontr Surg 2000;105(4):1314–1319CrossRefGoogle Scholar
  35. 35.
    Iwuagwu O, Bajalan A, Platt A, Stanley P, Reese R, Drew P: Macromastia and carpal tunnel syndrome: is there an association? Aesthetic Plast Surg 2006;30(5):535–537CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Luis R. Pernia
    • 1
  • Genelle Pernia
    • 2
  1. 1.Tuscaloosa CampusUniversity of Alabama at BirminghamTuscaloosaUSA
  2. 2.PGY2, Montgomery Family Medicine Residency ProgramMontgomeryUSA

Personalised recommendations