Sunday, October 10, 2004

Title: The Vertical Reduction Mammoplasty: A Prospective Analysis of Patient Outcomes

Jason A. Spector, MD, Alfred T. Culliford, MD, Rebecca Kleinerman, BA, and Nolan S. Karp, MD, FACS.

Intro: Reduction mammoplasty (RM) is one of the most frequently performed plastic surgical procedures. Traditional RM, performed via an inverted “T” incision on the breast, has been shown to reliably improve patient quality of life and relieve symptoms associated with macromastia. More recently, vertical reduction mammoplasty (VRM), also known as “short scar” breast reduction, has grown in popularity with both surgeons and patients as the breast reduction procedure of choice. To date, there is a paucity of prospectively collected data concerning patient outcomes after VRM. Herein, we present a cohort of such patients.

Methods: Beginning May 1, 2002, all patients undergoing RM in our office were asked to fill out a standardized questionnaire which detailed their pre-operative symptomatology (i.e. back pain, breast pain, arm pain, headache, etc.) and vital statistics (i.e. height, weight, bra size, etc.). Symptoms were rated on a scale from 1 (none/never) to 5 (always). These patients were then given the same questionnaire at their final post-operative office visit approximately 6 months after surgery. For patients who declined to come in for a final visit, the questionnaire was returned via mail. Statistical comparisons of pre- and post-operative symptoms were made using the paired Student’s t-test with a level of significance defined as p<0.05. Results: Thus far 71 patients have completed their pre- and post-operative questionnaires. Of this group 24 breast reductions were performed via traditional inverted “T” incisions, the remaining 47 were VRM based on a medial pedicle. The average weight reduction in the VRM group was 541g per breast, with a range of 320g to 1050g, and the average post-operative reduction in bra cup was 2 sizes. As a group, the VRM patients demonstrated statistically significant post-operative reductions in major macromastia related symptoms such as upper back and lower back pain (symptom scores of 3.86 and 3.65 respectively, pre-op vs 1.50 and 1.50 respectively, post-op), neck pain (3.58 pre-op vs 1.33 post-op), painful shoulder grooving (4.42 pre-op vs 1.17 post-op), all with p <0.0001. Quality of life factors such as difficulty purchasing clothes and bras and difficulty playing sports were also significantly improved (symptom scores of 4.66 and 4.39 respectively, pre-op vs 1.31 and 1.25 respectively, post-op), all with p<0.0001. There were no major complications such as re-admission for infection, re-operation for bleeding or nipple loss. Minor complications such as superficial infection, seroma requiring aspiration or delayed wound healing occurred in 15% of patients. Minor (office) revisions were performed in 5% of patients.

Conclusions: We have demonstrated in prospectively collected data that the vertical reduction or short scar mammoplasty provides significant relief of patient symptoms. Furthermore, VRM is a reliable procedure even in moderately large breasts (>500g). We anticipate that these prospective data will serve to further enhance the increasing popularity of the VRM among patients and surgeons alike. Finally, given the vast improvement seen in patient quality of life after operation, the data provided herein should serve to promote health care coverage of such procedures, even in “smaller” reductions which may currently be disqualified from coverage.

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