Breast hypertrophy creates a functional disability, adversely affecting quality of life because of disproportionate upper body weight. No study to date has prospectively shown or statistically proved (using validated questionnaires) the functional benefits of breast reduction surgery. Moreover, no study has quantified the physical findings seen in these patients. A prospective trial was designed to illustrate objectively the functional benefits of breast reduction surgery and answer the question, Does surgically removing breast tissue in symptomatic patients (regardless of amount of tissue removed) improve their physical disabilities related to breast hypertrophy, and in turn, improve their quality of life? Fifty-five consecutive patients with an average age of 38 years (range, 18 to 73 years) undergoing breast reduction surgery by the senior surgeon (L.A.C.) were recruited for this study. The North American Spine Society (NASS) Lumbar Spine Outcome Assessment Instrument was used to assess patients' disability, expectations for treatment, and satisfaction with treatment. The visual analogue scale was used to quantify pain intensity. Muscle strengths of the pectoralis major, pectoralis minor, rhomboid, middle trapezius, and lower trapezius muscles and postural measures were obtained. Information was collected preoperatively and 6 months postoperatively for comparison. The mean cumulative preoperative NASS Lumbar Spine Outcome Assessment Instrument disability score was 1.94 ± 0.68, and the mean cumulative postoperative disability score was 1.16 ± 0.35 (p = 0.0001); 96.1 percent of patients met expectations to a certain degree and, of these patients, 96 percent were very satisfied with their surgery. The mean cumulative baseline preoperative visual analogue score for all participants was 6.2 ± 2.06, and their mean cumulative postoperative score was 0.53 ± 0.88 (p = 0.0001). There was statistically significant improvement of muscle strength in the rhomboids, middle trapezius, and lower trapezius muscles (p < 0.001). All postural measures showed improvement postoperatively, with head translation and cranial rotation showing statistical improvement (p < 0.05). This single-center, single-surgeon breast reduction outcome study showed that the signs and symptoms of breast hypertrophy are definable in a consistent manner. By standardizing and quantifying preoperative and postoperative evaluations with validated questionnaires, validated pain scoring, and standardized muscle and posture testing, it was shown that breast reduction for symptomatic breast hypertrophy can effect a statistically significant improvement in these objective measures of pain, disability, muscle weakness, and poor posture.
Breast hypertrophy is thought to create a functional disability, adversely affecting quality of life because of disproportionate upper body weight. Breast reduction is a surgical therapy performed to reduce breast weight in symptomatic women. Women with breast hypertrophy complain of neck, shoulder, upper back, and breast pain at rest and with exercise. 1-11 In 1993, Gonzalez described many of the signs of breast hypertrophy including rounded shoulders resulting from forward rotation of the scapulae, shoulder grooves from brassiere straps caused by excessive weight of the breasts, long and pendulous breasts, and intertrigo from maceration in the inframammary crease. 7 Other studies have implicated breast hypertrophy in an increased incidence of carpal tunnel syndrome, 12 and Letterman and Schurter described the mechanism by which hypertrophic breasts affect the skeletal system. 13
Breast reduction surgery is widely believed to reduce neck, shoulder, and upper back pain; improve body image and posture; and improve shoulder and back function. 1-9,14,15 In addition, this procedure is thought to improve a patient's quality of life. Retrospective studies support the theory that breast reduction surgery establishes a more normal appearance with reasonable breast symmetry; typically, patients report a high degree of satisfaction. 11,16,17 Several studies have asked patients for information regarding their preoperative and postoperative pain, activity, disability, analgesic use, and emotional well-being. 2,6,18-21 Recent prospective studies with 6-month to 2-year follow-ups have concluded that breast reduction surgery eliminates the symptoms of breast hypertrophy and improves quality of life. 22-24
Nonetheless, third-party payors and managed care plans continue to doubt the medical necessity of surgical breast reduction for patients with symptomatic breast hypertrophy. 25-28 There has been controversy regarding whether breast reduction is a functional or a cosmetic procedure, because one of the goals of the surgery is to establish an aesthetically perfect breast that has normal values.29-33 Current insurance evaluation methods, in general, are arbitrary. Some of the parameters include amount of tissue removed (approxi-mately 500 g per breast), intertrigo, shoulder grooving, and long and pendulous breasts, as measured by the sternal notch-to-nipple distance (SNTND). The controversy related to the proven efficacy of breast reduction surgery exists because the literature supports the theory that reducing the amount of breast tissue improves the signs and symptoms of macromastia but does not adequately prove it with objective scientific data. In addition, no study published to date has prospectively shown or statistically proved (using validated questionnaires) the functional benefits of breast reduction surgery in patients with macromastia. Moreover, no study has quantified the physical findings seen in these patients. A study is needed to illustrate objectively the functional benefits of breast reduction surgery. For these reasons, we wish to finally answer the question, Does surgically removing breast tissue in symptomatic patients (regardless of amount of tissue removed) improve their physical disabilities related to breast hypertrophy, and in turn improve their quality of life?