Biomechanische Belastungen vor und nach operativer Therapie der Mammahypertrophie

Patients with bilateral breast hypertrophy suffer from a variety of physical symptoms including pain in the shoulder girdle, neck pain and pain in the thoracic and lumbar spine. The heavy weight of the breasts cause deep bra strap grooving as well as consecutive ulnar paresthesia. Degenerative changes of the spine are found in many of these women. Bilateral breast reduction is the only causal therapy. Conservative treatment has not been shown to be effective in long term. To date, hypertrophic breasts are not officially recognised as a pathological condition. Most of the published studies consist of quality of life questionnaires that have gathered subjective data. These are not accepted by health insurance companies. As a result, health insurance companies do not cover the costs of the operative treatment. As a consequence there is a high demand for objective data. So far, there exist a few studies concerning static aspects of the burden caused by hypertrophic breasts in the medical literature. They mainly consider the static weight of the breast without regard to any dynamical mechanisms. For the first time this study presents a method to measure the dynamic processes in patients with bilateral breast hypertrophy. We recorded the actual forces that affect the skeletal system and as a direct consequence the potential burden put on joints, the spine as well as other affected body areas. Seven patients who underwent bilateral breast reduction were recruited from the Department of Gynaecology of the Phillips-University of Marburg. They were measured before and after surgery by a motion capture system (Vicon) at the Institute for Biomechanics and Orthopedics at the German Sports University in Cologne. With this measurement setting we acquired video-sequences while patients walked and ran at increasing speeds on a treadmill using three cameras on different positions. The right breast as well as the right clavicula were marked by retroflective markers. During every video-sequence, patients were illuminated by spotlights so that the retroflective markers could be recognised, digitalized and analysed by the Motus® software. From this data, various biomechanical parameters were calculated. After breast reduction, the analysis revealed a distinct reduction of the extent of breast displacement in relation to the torso. Breast forces and torque also underwent an overproportional reduction. The method presented in this study enables it to measure the dynamic burden of patients with breast hypertrophy and thereby the potential burden of the skeletal system. These results facilitate not only to objectify the load but also the symptoms of those patients. They demonstrate a reduction of all biomechanical parameters and therefore show that reduction mammoplasty is effective. The presented study proves that the burden of breast hypertrophy is measurable. Therefore, the method enables further studies, e.g.: Our measurement setup can be run with additional marks of the skeleton including the vertebral column. With this the actual burden of the spine and the joints can be measured. Additionally, the subpopulation of women with lower resection weights can be measured separately. These patients often represent borderline cases, and an objective assessment would facilitate the decision concerning the approval for cost coverage by health insurances.