Background

Reduction Mammaplasty is an established procedure performed mainly by plastic surgeons for the relief of physical pain and discomfort associated with heavy pendulous breast. A number of breast reduction techniques have been developed over the years, but debate over which technique is better for the patients continue to grow. There are no published reports of the practices and preferences of plastic surgeons. Our goal is to survey members of the American Society of Plastic and Reconstructive Surgeons to identify their preferences and practices and report their opinion regarding issues related to the various Breast Reduction techniques.

Methods

In the fall of 2006, a one-page anonymous survey was sent to 5112 plastic surgeons who were members of the American Society of Plastic and Reconstructive Surgeons. A follow-up survey was sent 2 weeks after the first mail out as a friendly reminder. The questionnaire was then collected over a 6 week period.

Results

Of the 5112 plastic surgeons surveyed, 2666 (52%) responded to the survey. The majority of the respondents (69.4%) use the inferior pedicle breast reduction technique. The second most common technique was medial pedicle mammaplasty (Hall-Finley) at 14.5%. For mild macromastia and grade I ptosis, 24.6% of responders would use the inferior pedicle technique, and 20.8% would use the periareolar reduction technique. For moderate macromastia with either grade II ptosis or grade III ptosis, the inferior pedicle technique was used in 54% and 69% respectively. Sixty percent used inferior pedicle technique for severe macromastia with grade III ptosis. All of these differences were statistically significant (P-value<0.001). Less than 1% of respondents use liposuction as a sole method of breast reduction, however, 49% use it as an adjunct. Ninety two percent of the responders use intraoperative DVT prophylaxis. Sixty one percent of respondents performed over 75% of their cases as an outpatient. The average blood loss was between 50-150 mL and 96.7% of responders use general anesthetic with or without local anesthetic. Ninety three percent of the respondents use preoperative antibiotic and 74% use postoperative antibiotic. Over 70% of the respondents do not think breast reduction is or should be a cosmetic procedure.

Conclusion

In conclusion, the inferior pedicle technique has traditionally been the procedure of choice and remains so today. However, there has been an increase in the use of the newer techniques. Plastic surgeons are becoming more cognizant of the risk of deep venous thrombosis among their patients. The majority of the breast reduction is now performed as an outpatient procedure.