Abstract: Objective To investigate factors influencing surgical decision-making in women with severe breast hypertrophy and provide a reference for procedure selection. Methods A total of 105 women with severe breast hypertrophy who attended the Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital between January 2024 and March 2025 were retrospectively included. Demographic characteristics, clinical symptoms, surgical expectations and preferences for surgical techniques were collected. A standardized image-based educational protocol was adopted to assist preoperative counselling, and surgical preferences were compared between patients with different levels of understanding about breast reduction. Results The mean age of the patients was (38.46±9.21)years and the mean BMI was (25.28±4.66)kg/m². Shoulder and back pain were present in 61.9% and 55.2% of patients, respectively; 87.6% reported limitations in physical activity and 66.7% reported psychological distress. Preoperatively, only 50.5% of patients rated themselves as “clearly understanding the surgical procedure, and 68.6% obtained information through social media. Patients commonly expected postoperative breast volume reduction,improved symmetry, correction of ptosis and inconspicuous scars; the preferred postoperative cup size was mainly a B cup (52.1%) or “as small as possible” (30.1%). Before counselling, only 48.6% of patients tended to prefer an inverted-T incision, whereas after counselling, 97.3% (71/73) chose this incision pattern. Conclusions Patients with severe breast hypertrophy have relatively high acceptance of breast reduction surgery but exhibit limited systematic understanding of the procedure. Targeted preoperative counselling optimizes surgical decision-making for breast reduction in these patients and increases patients' acceptance of the inverted-T incision.

Key words: severe breast hypertrophy, breast reduction surgery, surgical decision-making, patient preference