INTRODUCTION: Women with symptomatic macromastia often complain of back and neck pain, headaches, shoulder grooving and upper extremity numbness.1–3 Such symptoms are responsible for a significant number of lost work days per year adding an economic burden to women with macromastia.
METHODS: A prospective cohort study was performed to evaluate the number of lost work days resulting from back or neck pain when women with symptomatic macromastia were managed with nonsurgical versus surgical treatment. Working women with symptomatic macromastia were requested to prospectively record the number of days lost from work as a result of back or neck pain associated with their large breasts during the 6 months period of conservative management required by their managed care medical policy. The conservative management included physical therapy, weight loss and analgesics. A reduction mammoplasty was approved and performed in all the women following the period of conservative management. After the women returned to work, they were again requested to record the number of lost work days associated with back or neck pain. Comparison between the number of lost work days with conservative management versus surgery was performed. Data collection included demographic questions as well as bra cup size, height, weight, level of education and employment. The gender-specific median wage rates from the Bureau of Labor Statistics were used to estimate the economic value of lost work days annually.4 The difference between groups was evaluated using Student’s t-test or Chi-square test, whichever was appropriate, with a p-value of less than 0.05 being considered significant. This study was approved by the Institutional Review Board.
RESULTS: The study evaluated 128 women with symptomatic macromastia. The mean age was 32 ± 10, the mean body mass index was 29 ± 4, mean bra size was 38-D, 45% had a college degree or higher, and 90% had full-time employment. The mean number of lost work days was 6 ± 3 with conservative and 1 ± 1 with surgical management in a 6 months period, a difference that was statistically significant (p<0.05). Based on gender-specific median wage rates from the Bureau of Labor Statistics, this represents an economic loss of $1,497 annually per woman in conservative management.
CONCLUSION: Women with symptomatic macromastia have significantly fewer days lost from work when a reduction mammoplasty is performed. Conservative management results in a higher cost in loss productivity.
1. Collins ED, Kerrigan CL, Kim M, et al. The Effectiveness of Surgical and Nonsurgical Interventions in Relieving the Symptoms of Macromastia. Plast Reconstr Surg. 2002;109:1556–1566.
2. Nguyen JT, Wheatley MJ, Schnur PL, Nguyen TA, Winn SR. Reduction Mammaplasty: A review of Managed Care Medical Policy Coverage Criteria. Plast Reconstr Surg. 2008;121:1092–1100.
3. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Understanding the Health Burden of Macromastia: Normative Data for the BREAST-Q Reduction Module. Plast Reconstr Surg. 2017;139:846e-853e.
4. Bureau of Labor Statistics. Labor Force Statistics from the Current Population Survey. US Department of Labor; 2016. Available at https://www.bls.gov/cps/cpsaat39.htm. Accessed on December 3, 2017.