Economic constraints and diminished healthcare resources mandate increased efficiency in labor intensive plastic surgical procedures such as reduction mammaplasty. The evolution to our current approach over a nine-year period was analyzed to identify those factors that maximize patient satisfaction outcomes while reducing physician resources. From 1992-2001 a total of 518 patients underwent bilateral reduction mammaplasty (1,036 total breast resections) by a single plastic surgeon. Since 1992 we used a bilateral simultaneous approach to reduction mammaplasty, with the primary surgeon performing the preoperative markings and determining the final resection. An inferior pedicle, "inverted T" technique using a Wise pattern was used for all cases. The initial two years (113 consecutive patients; 1992-1994) were compared to the most recent two year period (103 patients; 1999-2001) and variables which increased patient satisfaction while decreasing operative times and resources were identified. Length of stay (admission to discharge) was initially 27 hours (overnight stay) and decreased to 5 hours (outpatient surgery center) in the most recent group. Drains were used in 100% of the earlier cases but since 1995 were used selectively and in only 7% in the recent series. Major complications occurred in 3% including 3 unilateral hematomas and complete bilateral nipple loss in one patient. Minor wound separations occurred in 10%. In the recent series 97% of patients received complete relief of their preoperative symptoms and expressed satisfaction with their results. Unilateral decreased nipple sensation occurred in 13%. Operative times (incision to close) decreased to 102 minutes. Dermabond skin adhesive was used in all patients in the most recent series. An evolutionary approach to bilateral reduction mammaplasty with low complication rates and high patient satisfaction is presented. Optimization of technique leads to decreased operative times, shortened lengths of stay, and contributes to efficient use of surgeon and operating room resources.
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