In sub-Saharan Africa, there are very few publications on reduction mammaplasties. With this significant 15-year perspective, it seemed important to me to present the results of my reduction mammaplasties in African women, as well as the challenges faced in a country with limited resources. Over a 15-year period, from 2010 to 2025, I performed 92 bilateral reduction mammoplasties on 46 African patients in Kinshasa, Democratic Republic of Congo. The average age of the patients was 34.2 years, ranging from 17 to 60 years. The most common breastfeeding rate was 4, found in 11 patients (23.9%), and these 11 patients were aged between 30 and 49 years. The 92 mammoplasties performed were all reduction mammoplasties using a dermoglandular flap with a supeio-internal pedicle. In my series, the main complications were partial necrosis of the nipple-areola plate (2%), hematomas (6.2%), infectious complications (6.4%), scar dehiscence (6.8%), and hypertrophic and/or keloid scars (10.2%). The results were considered excellent (91.3%) from an aesthetic point of view. And, all my patients were satisfied with the results of their reduction mammaplasties, with a follow-up ranging from 12 months to 14 years. Despite my excellent results obtained with patient satisfaction, the two major challenges to overcome, in this country with limited resources and a high incidence of keloids, are patient poverty and the unpredictable occurrence of pathological scars (hypertrophic, keloid).
References
[1]
Léger, M. (2024) Mammoplastie de réduction: Analyse des pratiques chez les chirurgiens plasticiens français en 2024. Médecine humaine et pathologie.
[2]
McKissock, P.K. (1972) Reduction Mammaplasty with a Vertical Dermal Flap. Plastic and Reconstructive Surgery, 49, 245-252. https://doi.org/10.1097/00006534-197203000-00001
[3]
Lonie, S., Sachs, R., Shen, A., Hunter-Smith, D.J., Rozen, W.M. and Seifman, M. (2019) A Systematic Review of Patient Reported Outcome Measures for Women with Macromastia Who Have Undergone Breast Reduction Surgery. Gland Surgery, 8, 431-440. https://doi.org/10.21037/gs.2019.03.08
[4]
Pinsolle, V., Tierny, C., Héron, A., Reynaud, P. and Pélissier, P. (2019) Résultats défavorables de la mammoplastie de réduction: Causes, prévention et traitements. Annales de Chirurgie Plastique Esthétique, 64, 575-582.
[5]
Dieffenbach, J.F. (1848) Die Extirpation der Bruestdruese. In: Dieffenbach, J.F., Ed., Die Operative Chirurgie, Brockhaus, 359-373.
[6]
Pousson (1897) Bulletin et Memoire de la Societe de Chirurgie de Paris.
[7]
Mitz, V. (2023) Technique de reconstitution des piliers du sein au cours des mammoplasties. Annales de Chirurgie Plastique Esthétique.
[8]
Bruant-Rodier, C. and Bodin, F. (2010) Plasties mammaires pour hypertrophie et ptôse (I). Principes généraux. EMC—Techniques chirurgicales—Chirurgie plastique reconstructrice et esthétique, 5, 1-17. https://doi.org/10.1016/s1286-9325(10)50080-3
[9]
McKissock, P.K. (1979) Reduction Mammaplasty: How I Do It. Annals of Plastic Surgery, 2, 321-331. https://doi.org/10.1097/00000637-197904000-00010
[10]
Daane, S. and Rockwell, W. (1999) Breast Reduction Techniques and Outcomes: A Meta-Analysis. Aesthetic Surgery Journal, 19, 293-303. https://doi.org/10.1053/aq.1999.v19.100635001
[11]
Sankale, A.A., Bouchama, A. and Ndi, A. (2012) Les hypertrophies mammaires: Étude préliminaire à Dakar. Mali Médical, 27, 23-26.
[12]
Sidibé, B.Y., Bah, A., Koné, T., et al. (2022) Gigantomastie gravidique bilaterale et morbide au CHU Gabriel Touré: À propos d’un cas. Jaccr Africa, 6, 121-126.
[13]
Kibadi, K., Mpiana, L., Bilonda, K., Kilembe, M. and Lokengo, K. (2012) Reduction Mammoplasty Using Dermoglandular Flap with Superior and Internal Pedicle. Annales Africaines de Médecine, 5, 1181-1186.
[14]
Mojallal, A., Comparin, J.P., Voulliaume, D., Chichery, A., Papalia, I. and Foyatier, J. (2005) Place de la réduction mammaire à pédicule supérieur dans les gigantomasties. Annales de Chirurgie Plastique Esthétique, 50, 118-126. https://doi.org/10.1016/j.anplas.2004.09.004
[15]
Loury, J., Piquet, M., Letertre, P., Pauchot, J. and Tropet, Y. (2010) Étude rétrospective des complications et imperfections: À propos de 100 cas de mammoplastie de réduction à pédicule supérieur. Annales de Chirurgie Plastique Esthétique, 55, 187-194. https://doi.org/10.1016/j.anplas.2009.06.011
[16]
Malidor, D. (2025) Traitement chirurgical de l’hypertrophie mammaire par lambeau vertical bipédiculé selon la technique de Mac Kissock. Etude d’une série de 102 cas. Thèse doctorat en médecine n°105, 17-26.
[17]
Pitanguy, I. (1967) Surgical Treatment of Breast Hypertrophy. British Journal of Plastic Surgery, 20, 78-85. https://doi.org/10.1016/s0007-1226(67)80009-2
[18]
Wise, R.J. (1956) A Preliminary Report on a Method of Planning the Mammaplasty. Plastic and Reconstructive Surgery, 17, 367-375. https://doi.org/10.1097/00006534-195605000-00004
[19]
Weiner, D.L., Aiache, A.E., Silver, L. and Tittiranonda, T. (1973) A Single Dermal Pedicle for Nipple Transposition in Subcutaneous Mastectomy, Reduction Mammaplasty, or Mastopexy. Plastic and Reconstructive Surgery, 51, 115-120. https://doi.org/10.1097/00006534-197302000-00001
[20]
Letertre, P., Lasserre, G. and Ricbourg, B. (2009) Traitement des hypertrophies mammaires très importantes et des gigantomasties par la technique de réduction dite à pédicule postéro-inférieur. À propos de 20 cas. Annales de Chirurgie Plastique Esthétique, 54, 331-339. https://doi.org/10.1016/j.anplas.2008.10.004
[21]
Metaxotos, N.G., Asplund, O. and Hayes, M. (1999) The Efficacy of Bupivacaine with Adrenaline in Reducing Pain and Bleeding Associated with Breast Reduction: A Prospective Trial. British Journal of Plastic Surgery, 52, 290-293. https://doi.org/10.1054/bjps.1998.0129
[22]
Kibadi, K., Muhota, D.K., Mudimisi, F.N., Mufasoni, S.M., Mukendi, Y.M.W., Mukendi, A.T., et al. (2012) Keloids: Epidemiological Aspects and Reasons for Refusal of Surgical Treatment in Kinshasa (Democratic Republic of Congo). Médecine et Santé Tropicales, 22, 182-186. https://doi.org/10.1684/mst.2012.0055
[23]
Wang, A.T., Panayi, A.C., Fischer, S., Diehm, Y.F., Tapking, C., Hundeshagen, G., et al. (2022) Patient-Reported Outcomes after Reduction Mammoplasty Using BREAST-Q: A Systematic Review and Meta-Analysis. Aesthetic Surgery Journal, 43, NP231-NP241. https://doi.org/10.1093/asj/sjac293
