Combined oral contraceptives (COCs) that contain both estrogen and progestin do not contribute to enlarged breast growth (macromastia) — nor do they increase the risk of breast regrowth in adolescent girls and young women after breast reduction surgery, according to a study in the October issue. Plastic and reconstructive surgery®And the The official medical journal of the American Society of Plastic Surgeons (ASPS). The magazine is published in the Lippincott Portfolio by Wolters Kluwer.
Alternatively, oral contraceptive use during adolescence may actually be associated with less severe breast enlargement (enlargement), according to new research from ASPS member surgeon Brian I. Labo, MD, of Boston Children’s Hospital and Harvard Medical School and colleagues.
Physicians are encouraged to consider oral contraceptives for young women with large muscles
Breast reduction surgery, or breast reduction, is an effective treatment for reducing pain and psychosocial problems in adolescents and women with large muscles. Combined oral contraceptives are the most widely used type of hormonal contraceptive. In addition to their contraceptive effects, oral contraceptives are prescribed to manage a wide range of conditions in adolescents, including acne, menstrual disorders, endometriosis, and polycystic ovary syndrome.
“Despite the positive benefits of oral contraceptives, many patients, parents, and providers are concerned that their use may exacerbate adolescent breast enlargement,” wrote Dr. Labo and co-authors. They note that “the Internet is replete with anecdotal accounts and public articles suggesting that COC use in adolescents and young women may lead to breast development.” Although oral contraceptives can cause breast tenderness and swelling due to fluid retention, there is no high-quality evidence that they cause “true adenomatous hyperplasia” in young women.
What is the true effect of oral contraceptives on breast enlargement and symptoms in girls and young women? The study included 378 patients, ages 12 to 21, undergoing breast reduction surgery at Boston Children’s Hospital. The severity of hypertrophy was compared for patients who used and did not use oral contraceptives and other HCs, along with breast regrowth in the first year after breast reduction surgery.
The results were compared with those in a control group of 378 patients of the same age. The median age was about 18 years in both groups. Megaloblastic patients were more likely to be overweight or obese, consistent with the fact that increased body weight is a risk factor for megakaryocytosis.
In general, patients with macromastia had less use of HCs: about 38%, compared to 65% in the control group. However, among women using HCs, women with COCs were more likely to be prescribed significant oral contraceptives: 83% versus 53%. Dosages of estrogen and progestin were similar between groups.
Among patients with hypertrophy, oral contraceptive use does not appear to affect the severity of breast enlargement. The amount of breast tissue removed during breast reduction was similar between the groups (adjusted for height and weight) – in fact, somewhat less in patients who used oral contraceptives, compared to those who did not use HC. Other large muscle pain and symptoms (such as breast skin irritation, difficulty exercising, or problems finding appropriate clothing) were also similar between groups.
At a median follow-up of approximately 2 years after breast reduction, there was no significant difference in the rate of breast regrowth between patients who used and did not use combined oral contraceptives. Overall, about 5% of patients had breast regrowth after surgery. About half of the cases were due to regrowth of the breast gland, not related to being overweight. There was also no increased risk of breast regrowth in women who used oral contraceptives after breast reduction surgery.
Dr. Labo and colleagues believe the findings help refute the “widespread anecdotal claims” that oral contraceptives during adolescence may increase the risk of developing large muscles. They concluded: “Although more research is needed, providers are encouraged to consider oral contraceptives when prescribing HCs to their hypertrophic patients when indicated and appropriate.”
Nuzzi, L. C., et al. (2022) The effect of oral contraceptives on hypertrophic adolescents. Plastic and reconstructive surgery. doi.org/10.1097/PRS.0000000000009513.