Shared Medical Appointments for Adolescent Breast Reduction

Patient-Reported Outcomes After Reduction Mammoplasty Using BREAST-Q: A Systematic Review and Meta-Analysis

BACKGROUND

The BREAST-Q questionnaire reduction module is an established tool for outcomes after reduction mammoplasty.

OBJECTIVES

This systematic review and meta-analysis assess key parameters affecting pre- and postoperative scores, with specific foci on patient characteristics and tissue resection weights.

METHODS

This study was conducted per PRISMA guidelines. PUBMED (National Institutes of Health; Bethesda, MD), Google Scholar (Google; Mountain View, CA), and Web of Science (Clarivate Analytics; Philadelphia, PA) were searched. All studies published before August 1, 2021, were assessed for eligibility by 2 independent reviewers. Inclusion criteria were prospective or retrospective studies in 6 languages that reported quality of life after reduction mammoplasty employing the BREAST-Q questionnaire reduction module. Quality of included studies was assessed employing the Newcastle-Ottawa-Scale. Analysis was performed per Cochrane Collaboration and the Quality of Reporting of Meta-analyses guidelines.

RESULTS

A total of 28 papers were included in the systematic review, 13 for preoperative meta-analysis, and 17 for postoperative meta-analysis. Postoperative scores in all 3 quality of life domains (psychosocial, physical, and sexual well-being) and satisfaction with breasts increased significantly after reduction mammoplasty compared with preoperative scores. Satisfaction with breasts showed the greatest improvement, from 22.9 to 73.0. Preoperative scores were lower than normative data, with improvement to comparable scores as the healthy population postoperatively. Improvements in BREAST-Q scores did not correlate with patient comorbidities, complication rates, or amount of breast tissue resected.

CONCLUSIONS

Reduction mammoplasty provides marked improvement in BREAST-Q patient-reported quality of life as well established in literature. However, these improvements do not correlate with tissue resection weights, warranting further inquiry of insurance-defined resection requirements.

LEVEL OF EVIDENCE: 3

Analysis of adolescent patient satisfaction and well-being following reduction mammaplasty using the BREAST-Q survey

BACKGROUND

While functional breast reduction surgery has been shown to lead to increased quality of life in adult patients, the effects of this operation has not been investigated as thoroughly in adolescent patients. This study uses the BREAST-Q, a validated, surgery-specific questionnaire, to measure changes in adolescent patient well-being and satisfaction following reduction mammaplasty.

METHODS

All patients presenting for breast reduction consultation between February and December 2016 were asked to complete the BREAST-Q. Post-operative surveys were completed at three-month follow up. A matched control cohort was established using patients who completed a pre-operative survey and were deemed appropriate surgical candidates, but then were denied by insurance and did not undergo surgery.

RESULTS

Of the 28 adolescent patients who presented for breast reduction consultation, 15 met inclusion criteria; 11 patients underwent reduction mammaplasty, and 4 patients were included in the control cohort. When these groups were compared, statistically significant improvements were observed in all BREAST-Q categories except for sexual well-being. Overall patient satisfaction correlated most highly to satisfaction with information.

CONCLUSIONS

This study examines quality of life outcomes in adolescent breast reduction patients using the BREAST-Q survey. Our findings indicate that adolescent patients have an improved quality of life following breast reduction, but that their satisfaction stems from different sources from those of adult patients. Further characterization of outcomes specific to young patients with surgically managed symptomatic macromastia will increase the practice of tailored, evidence-based medicine for adolescent patients.

LEVEL OF EVIDENCE

Treatment Study, Level III.