The influence of obesity and volume of resection on success in reduction mammaplasty: an outcomes study.
BACKGROUND
Indications for breast reduction surgery include neck pain, back pain, shoulder pain, and an intertriginous rash. Previous studies have established that bilateral breast reduction surgery is highly effective in relieving these symptoms. Third-party payers may refuse to cover breast reduction surgery for obese patients. In addition, some surgeons turn down obese breast reduction candidates, perhaps fearing that they will not achieve symptom relief or that the complication rate will be prohibitive. It is common for insurers to require an arbitrary minimum volume to be resected in order for them to reimburse for the procedure. This study was conducted to see whether patients with varying levels of obesity had any difference in surgical outcomes compared with nonobese patients with regard to symptom relief and complication rate. The authors also studied the relationship between volume of tissue resected and symptom relief and complication rate.


METHODS
One hundred eighty-six consecutive patients underwent bilateral breast reduction surgery performed by a single surgeon using the inferior pedicle Wise pattern technique or the free nipple graft technique. Body mass index was calculated for each patient.


RESULTS
Significant postoperative symptom relief occurred in 97 percent of patients. Statistical analysis demonstrated no difference among the various body mass index groups in terms of symptom relief or development of complications, nor was there any correlation between volume of tissue resected and relief of symptoms or complications.


CONCLUSIONS
The authors conclude that there is no justification for discriminating against obese patients in either the performance of breast reduction surgery or the provision of insurance coverage for the same. The authors find no justification for denial of insurance coverage for patients in whom lesser tissue volumes are to be resected.
Wagner
Douglas S
DS
Division of Plastic Surgery, Northeastern Ohio Universities College of Medicine, Summa Health System, Akron, Ohio, USA.
Alfonso
David R
DR
D000328:Adult; D001416:Back Pain / Q000453:epidemiology; D015992:Body Mass Index; D015897:Comorbidity; D005076:Exanthema / Q000453:epidemiology; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000453:epidemiology; D016896:Treatment Outcome