Prospective Study of Outcomes after Reduction Mammaplasty



Prospective Study of Outcomes after Reduction Mammaplasty

Brian J. Miller, MD, Steven F. Morris, MD, Leif L. Sigurdson, MD, Richard L. Bendor-Samuel, MD, Mike Brennan, MD, George Davis, MD, and Justin L. Paletz, MD.

Macromastia is commonly associated with physical symptoms including neck, back, shoulder and breast pain, painful bra strap grooving, intertrigo, poor posture and difficulty exercising. It is also often associated with psychological symptoms related to unwanted attention, difficulty finding clothing that fits and low self-esteem. Reduction mammaplasty is widely accepted by plastic surgeons as an effective means of relieving many of these symptoms.

Several studies have concluded that reduction mammaplasty benefits women with macromastia. Many of these studies were retrospective or did not make use of validated measures of health status.1-7 More recent studies have been prospective and have made use of validated outcomes tools, such as the Short Form-36 Health Survey (SF-36).8-14 The patient populations described by these studies may not be comparable to our patient population due to regional variation in the ways women are selected for reduction mammaplasty. For example, pre-approval for surgery is required in some provinces based on factors such as body mass index (BMI).

A prospective study of outcomes after reduction mammaplasty was designed in order to assess the effectiveness of reduction mammaplasty in our patient population, to compare preoperative and postoperative health status to the normal population, and to eventually examine the role of BMI and amount of reduction as predictors of outcome after reduction mammaplasty.

Methods: Patients were enrolled prospectively by six participating surgeons. Surgeons completed a preoperative assessment form documenting height, weight and physical exam findings for each patient. Surgeons also completed an operative note form, as well as postoperative assessment forms at 1 and 6 months after surgery describing the postoperative course, length of hospitalization, time of return to work and complications. Patients completed three health questionnaires preoperatively and again 6 months postoperatively to assess health status before and after surgery. These consisted of the Short Form-36 Health Survey (SF-36), the Rosenberg Self-Esteem Scale, and the Symptom Inventory Questionnaire - a questionnaire describing the presence and severity of breast related symptoms. SF-36 scores before and after surgery were compared to previously published Canadian normative data.15 Demographic data was also collected.

Results: Preoperatively, the most common bra cup size was DD (56%). Average BMI was 29.8 kg/m2. Breast pain on palpation was uncommon (4.3%), and shoulder grooving was almost always present (96%). The inferior pedicle technique was used most often (96%). Liposuction was occasionally performed at the time of reduction mammaplasty (13%). Drains were used in almost all cases (96%). Prophylactic antibiotics were used most of the time (74%). There were no intraoperative problems reported. The average hospital stay was 0.85 days. Average time until return to work was 26.4 days. The most common complication reported was delayed wound healing (19%). The majority of patients were employed full-time (56%), married (60%) and Caucasian (98%). Mean age was 40 yrs. Household income and education were varied.

Comparison of mean preoperative and postoperative SF-36 scores showed significant improvements in seven out of eight health domains and in the physical health summary scale (p ................
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