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How Does Volume of Resection Relate to Symptom Relief for Reduction Mammaplasty Patients?

Strong, Ben MBChB, MRCS(Ed); Hall-Findlay, Elizabeth J. MD, FRCSC

doi: 10.1097/SAP.0000000000000190
Breast Surgery
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Background Reduction mammaplasty surgery is well known to produce improvement in a wide range of symptoms associated with macromastia. Health care insurers frequently stipulate a minimum resection volume to qualify for coverage, limiting access to surgery for many. The authors aimed to identify whether small volume resections do produce symptomatic improvement, comparing preoperative and postoperative experience of symptoms across a range of tissue resection volumes.

Methods Reduction mammaplasty patients were given a custom-designed questionnaire at routine postoperative follow-up appointments, asking them to rate their preoperative and postoperative experience of 9 symptoms related to macromastia. Results were compiled and analyzed alongside data from patient case notes. Of 661 patients identified as being eligible for inclusion in the study, 410 had sufficiently complete data to proceed to statistical analysis. Patients were divided into 6 groups based on volume of breast tissue resected. A Schnur sliding scale percentile was also calculated for all patients. Statistical analysis of preoperative symptom prevalence and postoperative symptom change was carried out. Further analysis to examine for evidence of trend in symptom improvement across groups was implemented using the Jonckheere-Terpstra test for ordered alternatives.

Results Patients who go on to have larger volumes of breast tissue resected were found to experience back pain, shoulder grooves, breast pain, rashes under the breast, exercise intolerance, and poor posture more frequently than those who go on to have smaller resections (P < 0.0005 for all). However, across the range of resection volumes, preoperatively symptomatic patients experienced significant improvement in several symptoms. Results suggested that a larger resection volume may correspond with greater improvement in back pain, neck pain, and poor posture.

Conclusions We found that reduction mammaplasty has a positive impact on a range of symptoms, even with lower volume resections and regardless of body surface area–calculated adjustments. This adds further weight to the argument that patients should not be denied access to the surgery based on arbitrary volume restrictions. We advocate freedom for the surgeon to make a decision on potential benefits of surgery based around the needs of each individual patient.

From the *Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK; and †Banff Plastic Surgery, Banff, Alberta, Canada.

Received November 25, 2013, and accepted for publication, after revision, February 3, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Elizabeth J. Hall-Findlay, MD, FRCSC, Banff Plastic Surgery, Suite 340 Cascade Plaza, 317 Banff Ave, PO Box 2009, Banff, Alberta, Canada T1L 1B7. E-mail: ehallfindlay@banffplasticsurgery.ca, ben_strong@me.com.

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