Reduction mammaplasty for symptomatic macromastia: which factors influence the post-operative outcome?

Factors Affecting Patient Satisfaction in Breast Reduction Surgeries: A Retrospective Clinical Study

BACKGROUND

Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire.

METHODS

Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant.

RESULTS

Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m². Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001).

CONCLUSIONS

In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

"Topographic Shift": a new digital approach to evaluating topographic changes of the female breast

PURPOSE

To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans.

METHOD

The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift.

RESULTS

The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm).

CONCLUSION

The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté.

A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery

Patient satisfaction and outcomes following reduction mammoplasty is important to measure, being a being a reconstructive procedure with physical and cosmetic benefits. This study aimed to evaluate patient satisfaction and the various questionnaires that have been devised for this measurement. A systematic search of literature was performed in PubMed, Cochrane Library, Medline and Scopus databases from 1966 to July 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After application of pre-determined inclusion criteria by two authors, 95 articles were included. Data was extracted from included studies relating to demographics, surgical technique, questionnaires used and physical, psychological and aesthetic outcomes. Of the 95 studies included (9,716 patients), 58 studies (5,867 patients) reported on overall satisfaction with a mean rate of 90.26%. Researchers' own non-validated questionnaire was most commonly used in 52.6% of studies. Validated questionnaires used were most commonly the SF-36 (25.3%), Rosenberg self-esteem scale (RSES) (9.5%) and BREAST-Q (8.4%). All showed improvement in physical and mental health. Our findings suggest that women who have undergone reduction mammoplasty for breast hypertrophy report postoperative satisfaction and improvement in quality of life. Of the validated questionnaires used, a combination of those assessing both mental, physical and psychosocial health as well as breast-specific surveys were most commonly used and may provide an accurate assessment of patient outcomes.

A 12-year review of patient-reported outcomes after reduction mammoplasty in patients with high body mass index

Patients with increased body mass index (BMI) are often denied reduction mammoplasty due to concern for high morbidity. There is a paucity of evidence identifying high BMI as a predictor of poor long-term outcomes in reduction mammoplasty. In this study, we investigated the influence of BMI on long-term patient satisfaction following reduction mammoplasty.All patients undergoing reduction mammoplasty over a 12-year period at a single institution were included in the study. A retrospective chart review was conducted to extract demographics, operative data, and postoperative course including complications. Patients were classified into 4 categories based on BMI (normal (<25), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40)). Patient satisfaction was assessed using a customized survey which was administered over the phone. Only patients with complete medical records who participated in the survey were included.The 70 patients met the inclusion criteria for the study. Median time from surgery to survey was 6 years. Overall satisfaction after reduction mammoplasty was high, 5 on a 5-point Likert scale. The amount of breast tissue resected correlated with patient BMI (P <.01). There was no statistical difference in satisfaction across BMI classes. Furthermore, high BMI (obese, and morbidly obese) was not associated with higher postoperative complications (P = .70). Those with a high overall satisfaction score had a significantly greater self-reported aesthetic score compared to those with low and mid satisfied scores (P <.01).Following reduction mammoplasty, patients report high satisfaction which is sustained over several years. Obesity is not associated with a higher incidence of complications or lower satisfaction. Our data suggest that patients with a high BMI should not be denied reduction mammoplasty out of concern for higher complication rate or reduced patient satisfaction due to BMI alone, but reduction mammoplasty should be considered in the setting of overall health counseling.

Influence of the Preoperative Decision-Making Process on the Postoperative Outcome after Hysterectomy for Benign Uterine Pathologies

Introduction: The aim of this study was to assess whether the preoperative decision-making process might influence treatment success in premenopausal women undergoing hysterectomy for benign uterine pathologies Materials and Methods: All premenopausal women treated with hysterectomy for benign uterine pathologies between April 2011 and June 2013 at a tertiary university center were enrolled in this prospective observational cohort study. Five parameters of the preoperative decision-making process were assessed upon their correlation with postoperative quality of life, sexual function and patients' satisfaction. These outcome measures were assessed for the pre- and postoperative (six months after surgery) status using two validated questionnaires (EQ-5D and "female sexual function index" (FSFI). Patients' satisfaction with the postoperative outcome was assessed with a self-developed questionnaire. Results: 255 of 402 (63 %) patients completed the study. A correlation between the co-variables "interval between first counseling and decision to surgery", "subjectively perceived quality of the preoperative counseling" and "certainty in the decision for the intervention" and postoperative outcomes were found. The co-variables "person mainly responsible for election of hysterectomy mode" and "discussion of decision for surgery with others" showed no influence on postoperative patients-reported outcomes. Conclusion: We found a correlation between certain parameters of the preoperative decision-making process and postoperative patient-reported sexual function, quality of life and patients' satisfaction in premenopausal women undergoing hysterectomy for benign uterine pathologies. An optimization of these factors could contribute to an improvement in treatment outcomes.

Quality of Life Following Symptomatic Macromastia Surgery: Short- and Long-term Evaluation

Mammary hypertrophy or macromastia can cause a wide range of symptoms (physical, psychosomatic or behavioral), which affect patients' quality of life. Breast reduction can, in most of the cases, solve the problem. However, certain factors could have a negative effect on the outcome of surgery. The aims of this study were to discover the degree of patient satisfaction (short- and long-term) and to evaluate results of reduction mammoplasty, and also to ascertain which factors may have a negative role on the effectiveness of breast reduction surgery. We carried out a prospective and longitudinal study of 121 patients who underwent breast reduction surgery. Quality of life, outcome of surgery (complications and sequelae) and degree of patient satisfaction were evaluated at 1 month and at 1 year after reduction mammoplasty. Mean patient age was 40.71 (SD = 12.02). Among them, 35.5% were overweight, 44.6% were obese and 34.7% were smokers. The most common symptom was pain. The mean amount of resected breast tissue was 1785 g (SD = 876). A total of 27.3% of the patients suffered complications and 30.60% suffered sequelae. Our results show an improvement in symptoms (p < 0.001) and quality of life (p < 0.001 to p = 0.002) 1 month after and 1 year after breast reduction compared with the preoperative situation. Neither age, body mass index, smoking habit nor the amount of tissue removed had a negative effect on the results of surgery. One year after surgery, the majority of patients were satisfied with the outcome (96.6%), they would recommend it to others (96.6%), and they would undergo surgery a second time (95.8%).

CONCLUSIONS

Breast reduction is highly efficient in resolving symptoms and in improving quality of life. It leads to a high level of short- and long-term satisfaction irrespective of each patient's individual characteristics.

The expanded inframammary fold triangle: Improved results in large volume breast reductions

Context:

The inferior pedicle, Wise-pattern reduction mammaplasty is the most popular technique for breast reduction because of its reproducible results and reliability. However, complication rates in super obese patients or patients receiving large volume reductions are high, ranging from 35 to 78%. These complications include delayed healing, infection, seroma, nipple-areolar complex necrosis, fat necrosis and development of hypertrophic scars.

Aims:

This study aimed to determine whether a modification to the standard Wise-pattern reduction technique, an expanded inframammary fold skin triangle, produces improved outcomes in high-risk large volume breast reduction patients. We report that this modification leads to improved outcomes by decreasing wound complications and improving aesthetic appearance.

Settings and Design:

Twenty-two patients received the inferior pedicle Wise-pattern reduction mammaplasty, which was modified to include an 8 cm wide inferior pedicle. This pedicle was de-epithelialized and an 8 × 3 cm² triangle of skin was preserved at the inferior base to reduce tension at the triple point, inverted T-closure.

Materials and Methods:

A retrospective review was performed on all patients who underwent reduction mammaplasty with the expanded inframammary fold (eIMF) technique as well as all patients who received the standard wise pattern technique.

Statistical Analysis Used:

A student t-test was performed for both reduction populations using SPSS software package. Statistical significance was defined as P < 0.05.

Results:

The average patient age was 32.25 years old (range 18-59), average BMI was 35.0, and average tissue mass removed per breast was 1378.39 g. The modified technique was found to produce a statistically significant (P < 0.05) increase in the amount of breast tissue removed (693.96 g increase in the left and 571.21 g in the right) as well as a statistically significant (P < 0.05) reduction in dehiscence (75% reduction) and post-operative infection (44.10%).

Conclusions:

This method is an easily reproducible and reliable technique that produces a favourable cosmetic outcome with acceptable, sustainable results in high-risk reductions in obese patients.

Disparity between reported and measured patient weight: can it affect planning in breast reduction surgery?

BACKGROUND

Patient weights are frequently used in surgery for essential calculations including preoperative surgical planning, dosing of medications, and qualification for insurance reimbursement. Often, there is a disparity between patient-reported and actual measured weights. This study examines differences between self-reported and measured weights and implications in breast reduction surgery.

METHODS

A review was performed of 197 consecutive women who presented for breast surgery at an academic institution. Self-reported weights were recorded during the initial encounter, and the patients were subsequently weighed on the same day. A paired t-test was used to compare the self-reported and actual measured weights and stratified analysis performed based on body mass index (BMI). The Schnur sliding scale was used to estimate resection weights for reduction mammaplasty.

RESULTS

The overall mean difference in reported and measured weight was 3.0 lbs standard deviation (SD) 8.9 (P < 0.0001) with a maximum overestimation of 25 lb and underestimation of 80 lb. Statistically significant differences were found when stratified analysis was performed based on BMI as mean differences in the overweight (BMI 25-30) and obese (BMI > 30) groups were 1.7 lb SD 5.5 (P < 0.026) and 4.9 lbs SD 11.8 (P < 0.0002), respectively. Significant differences in calculated breast reduction resection weights, based on the Schnur sliding scale, were also found when comparing self-reported and measured weights in all groups.

CONCLUSIONS

Significant disparities between self-reported and measured weights were identified in patients presenting for breast surgery. These differences can influence important calculations of resection weights for breast reduction surgery. These differences may also affect dosing of medications and preoperative planning.