INTRODUCTION: With increased scrutiny of health care spending, the necessity of demonstrating benefit to patients after surgical interventions is growing. A number of studies have shown positive outcomes in patients after reduction mammaplasty. In the past, many of these studies were either retrospective or did not make use of a validated measure of health status. More recently, a number of prospective studies have been published and validated tools have been used to demonstrate benefit to patients following reduction mammaplasty. However, there has been little published regarding Canadian patient populations. Studies of different patient populations are of value as not all patient groups are comparable due to regional variation in selection criteria for reduction mammaplasty. OBJECTIVES: The goals of this study were: (1) to prospectively assess changes in overall health and breast-related symptoms in women undergoing reduction mammaplasty in Nova Scotia, Canada; (2) to assess preoperative physical findings, operative technique, postoperative course and complications related to reduction mammaplasty. METHODS: 50 patients were evaluated preoperatively and six months postoperatively with three questionnaires: (1)the Short Form-36 Health Survey (SF-36), a commonly used, validated measure of health status; (2) the Symptom Inventory Questionnaire which assessed the presence and degree of severity of several symptoms related to mammary hyperplasia; and (3) the Rosenberg Self-Esteem Scale, a widely used measure of self-esteem. Surgeons completed a preoperative patient assessment form which described the physical exam, multiple anthropomorphic measurements, and the presence of breast pain, masses or bra strap grooving. Operative data describing pedicle design, use of liposuction, infiltration, prophylactic antibiotics, operative time and intraoperative problems was collected. Surgeons also completed 3 month and 6 month postoperative patient assessment forms describing length of hospital stay, postoperative course and complications. STATISTICAL ANALYSIS: Preoperative and postoperative SF-36 scores were compared with a paired t-test. SF-36 scores before and after surgery were compared to age and gender matched Canadian population norms using an unpaired t-test. Postoperative changes in the presence and severity of breast symptoms and in the Rosenberg Self-Esteem Scale were assessed with the Wilcoxon Signed Ranks Test. P-values less than 0.05 were considered significant. RESULTS: Comparison of preoperative and postoperative health status showed significant improvements in seven out of eight health domains and in the physical summary scale of the SF-36 (p<0.01). Significant improvements were also seen in the Rosenberg Self-Esteem Scale (p<0.001). The Symptom Inventory Questionnaire demonstrated significant improvements in all breast related symptoms (p<0.01). When compared to the normal age-matched female population, preoperative SF-36 scores were significantly worse in the physical functioning, bodily pain and energy/vitality domains, as well as on the physical summary scale (p<0.0002). Postoperatively, none of the SF-36 scores were significantly lower than population norms and patients scored significantly higher than the normal population on the role physical, vitality and social function domains, as well as on the mental health summary scale (p<0.05). There was no significant change in nipple sensation. All patients felt that they would recommend this surgery to a friend. Preoperatively, the most common bra cup size was DD (56%). Average BMI was 29.8 kg/m2. Breast pain on palpation was uncommon (4.3%), and shoulder grooving was almost always present (96%). The inferior pedicle technique was used most often (96%). Liposuction was occasionally performed at the time of reduction mammaplasty (13%). Drains were used in almost all cases (96%). Prophylactic antibiotics were used most of the time (74%). There were no intraoperative problems reported. The average hospital stay was 0.85 days. Average time until return to work was 26.4 days. The most common complication reported was delayed wound healing (19%). The majority of patients were employed full-time (56%), married (60%) and Caucasian (98%). Mean age was 40. Household income and education were varied. CONCLUSION: This study determined that there is a significant improvement in health status in women undergoing reduction mammaplasty. Prior to surgery these patients have a significantly worse health status than the normal population, and normalize postoperatively.
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