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Randomized Controlled Trial Comparing Health-Related Quality of Life in Patients Undergoing Vertical Scar versus Inverted T–Shaped Reduction Mammaplasty

Thoma, Achilleas M.D., M.Sc.; Ignacy, Teegan A. B.Sc.; Duku, Eric K. Ph.D.; Patterson, Robert S. M.D.; Cin, Arianna Dal M.D.; Levis, Carolyn M. MD., M.Sc.; Goldsmith, Charles H. Ph.D.

Plastic & Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 48e–60e
doi: 10.1097/PRS.0b013e3182910cb0
Cosmetic: Outcomes Article
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Background: There is controversy regarding the superiority of the vertical scar reduction technique versus the inverted T–shaped reduction technique for breast reduction surgery.

Methods: Two hundred fifty-five patients were randomized to either the vertical scar reduction or inverted T–shaped reduction technique immediately before surgery over a 5-year period. Patients completed the Health Utilities Index Mark 3, Short Form-36, Breast-Related Symptoms Questionnaire, and Multidimensional Body-Self Relations Questionnaire at 1 week preoperatively and 1, 6, and 12 months postoperatively. Data were treated according to intention-to-treat principles. The primary outcome was the difference in the change in Health Utilities Index Mark 3 score from baseline to 12 months postoperatively between the two techniques.

Results: Patients undergoing either technique gained a statistically significant and clinically important improvement from baseline to 1 year postoperatively in the Health Utilities Index Mark 3 (vertical scar reduction, 0.81, 0.16 to 0.87, 0.19; inverted T–shaped reduction, 0.79, 0.20 to 0.89, 0.15) and the Breast-Related Symptoms Questionnaire (vertical scar reduction, 50.26, 12.98 to 95.59, 9.36; inverted T–shaped reduction, 50.06, 12.50 to 94.09, 9.86). No difference in mean change in scores from baseline to 12 months postoperatively was seen in any of the quality of life questionnaires between the techniques.

Conclusions: There was a clinically important improvement between baseline and 1 year postoperatively in both groups in the Health Utilities Index Mark 3 and the Breast-Related Symptoms Questionnaire. The authors conclude that the techniques are similar when quality of life is the outcome of interest.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Hamilton, Ontario; and Burnaby, British Columbia, Canada

From the Division of Plastic Surgery, Department of Surgery, the Department of Clinical Epidemiology and Biostatistics, the Surgical Outcomes Research Center, and the Department of Psychiatry and Behavioral Neurosciences, McMaster University; and the Faculty of Health Sciences, Simon Fraser University.

Received for publication September 14, 2012; accepted January 17, 2013.

Presented at the 16th World Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery, in Vancouver, British Columbia, Canada, May 21 through 27, 2011; the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012; and the 66th Annual Meeting of the Canadian Society of Plastic Surgeons, in Toronto, Ontario, Canada, June 5 through 9, 2012.

This trial is registered under the name “Vertical Scar Versus Inferior Pedicle Reduction Mammoplasty,” Clinical Trials.gov identification number NCT00149344 (http://clinicaltrials.gov/show/NCT00149344).

Disclosure: The authors have no financial disclosures or conflicts of interest with the content presented.

Achilleas Thoma, M.D., M.Sc., 206 James Street South, Suite 101, Hamilton, Ontario L8P 3A9, Canada, athoma@mcmaster.ca

©2013American Society of Plastic Surgeons