Effects of Reduction Mammoplasty on Upper-Limb Nerve Conduction Across the Thoracic Outlet in Women With Macromastia

Abstract

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.

Hereditary diffuse gastric cancer

“…In a large cohort of 151 women undergoing BBR for macromastia, Pernia et al5 reported increased prevalence of clinically diagnosed CTS at 19.9%, as compared with 3% in women in general 15. Iwuagwu et al3, 6 and Guerra et al7 have independently confirmed the increased prevalence of CTS in women undergoing BBR, based on EDx criteria.…”

“…The prevalence of CTS based on EDx criteria in our select group was 33.3%. Although the clinical features of CTS and proximal T1 denervation overlap, increased prevalence of CTS in women undergoing BBR has been reported in separate studies based on clinical and EDx criteria 3, 5–7. In a large cohort of 151 women undergoing BBR for macromastia, Pernia et al5 reported increased prevalence of clinically diagnosed CTS at 19.9%, as compared with 3% in women in general 15.…”

“…Patients with comorbid CTS and axonal loss in the distribution of the T1 APR were excluded if both median motor and sensory conduction delay were recorded across the wrist(s), because moderate to severe CTS can contribute to motor axonal loss and denervation of the abductor pollicis brevis (APB) muscle. However, patients with mild or very mild CTS, defined as isolated median sensory conduction slowing across the wrist(s), were included, in view of reported increased prevalence of CTS in women with macromastia 3, 5–7. Isolated mild delay in median motor onset latency without evidence of sensory conduction slowing across the wrist was not diagnosed as comorbid CTS if there was evidence of a proximal T1 lesion.…”

“…Symptoms are frequently described in a median and/or ulnar nerve distribution 1. Anecdotal reports of ulnar neuropraxia, “coracoid compression syndrome,” and “pseudothoracic outlet syndrome” have been described,2, 3 but localization and proposed pathophysiological mechanisms are not precise. Involvement of the T1 anterior primary ramus (APR) would be compatible with the clinical presentations detailed in many reports.…”

Chronic bilateral T1 denervation in women with macromastia

“…Although the clinical features of CTS and proximal T1 denervation overlap, increased prevalence of CTS in women undergoing BBR has been reported in separate studies based on clinical and EDx criteria. 3,[5][6][7] In a large cohort of 151 women undergoing BBR for macromastia, Pernia et al 5 reported increased prevalence of clinically diagnosed CTS at 19.9%, as compared with 3% in women in general. 15 Iwuagwu et al 3,6 and Guerra et al 7 have independently confirmed the increased prevalence of CTS in women undergoing BBR, based on EDx criteria.…”