(A) "Bottoming out" of the breasts
(B) Excessive reduction
(C) Inadequate reduction
(D) Loss of nipple sensation
(E) Prominent scarring

The correct response is Option E.

According to several retrospective studies, prominent scarring is the most common source of patient dissatisfaction following reduction mammaplasty. "Bottoming out" of the breasts, excessive or inadequate reduction, and loss of sensation are less commonly reported as sources of patient dissatisfaction. Although patient satisfaction is generally high on follow-up evaluation, preoperative discussion of the potential long-term complications of reduction mammaplasty should be a priority for the surgeon. Long-term complications such as those mentioned above have been shown to significantly affect the patient's perception of the postoperative results.

References
1. Davis GM, Ringler SL, Short K, et al. Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg. 1995;96:1106-1110.
2. McMahon JD, Wolfe JA, Cromer BA, et al. Lasting success in teenage reduction mammaplasty. Ann Plast Surg. 1995;35:227-231.

A 30-year-old woman who underwent reduction mammaplasty using the inferior pedicle technique 10 years ago is pregnant with her first child. The probability that she will breast-feed is closest to

(A) 10%
(B) 30%
(C) 50%
(D) 70%
(E) 90%

The correct response is Option B.

A large proportion of the women who seek breast reduction surgery are of child-bearing age. Because of the known advantages of breast-feeding, much attention has been directed toward the possibility of breast-feeding after reduction mammaplasty. In North American studies, 27% to 35% of postreduction patients were reported to have breast-fed in excess of two months. The most recent data indicate that 29% of women who had undergone inferior pedicle reduction mammaplasty (the procedure used on this patient) breast-fed either exclusively or with formula supplementation, 18% were unsuccessful in their attempt to breast-feed, and 53% did not attempt breast-feeding.

Preservation of adequate breast tissue connected to the nipple was thought to be paramount to subsequent breast-feeding success. There was no significant difference in the mass or volume of tissue excised between the groups that breast-fed and those with an unsuccessful breast-feeding attempt. No decision about breast-feeding was attributable to perioperative complications such as wound infection or necrosis. The prevalence of breast-feeding among postreduction mammaplasty patients falls near the breast-feeding rate found in the population of child-bearing women who did not undergo breast surgery.

References
1. Brzozowski D, Niessen M, Evans HB, et al. Breast-feeding after inferior pedicle reduction mammaplasty. Plast Reconstr Surg. 2000;105:530-534.
2. Harris L, Morris SF, Freiberg A. Is breast feeding possible after reduction mammaplasty? Plast Reconstr Surg. 1992;89:836-839.
3. Marshall DR, Callan PP, Nicholson W. Breastfeeding after reduction mammaplasty. Br J Plast Surg. 1994;47:167-169.