title: Maximizing outcomes in breast reduction surgery: a review of 518 consecutive patients.
abstract: BACKGROUND
  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 9-year period was reviewed.
  
  
  METHODS
  From 1992 to 2001 a total of 518 patients underwent bilateral reduction mammaplasty by a single plastic surgeon. Since 1992, a bilateral simultaneous approach to reduction mammaplasty was used, with the primary surgeon (Scott) 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 2-year period (113 consecutive patients from 1992 to 1994) was compared with the later 2-year period (103 patients from 1999 to 2001). Variables that decreased operative times and resources were identified.
  
  
  RESULTS
  Length of stay (from admission to discharge) was initially 27 hours (overnight admission at a hospital) in the early review and decreased to 5 hours (outpatient surgery center) in the recent series. Drains were used in 100 percent of the earlier cases and in 7 percent in the recent series. Major complications occurred in 3 percent of the entire series. Minor complications occurred in 20 percent of all patients. In the recent series 97 percent of patients received complete relief of their preoperative symptoms and expressed satisfaction with their results. Operative times decreased from 120 to 102 minutes. Beginning in 1999, Dermabond skin adhesive was used in all patients.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic Surgery, Kaiser Permanente San Diego, California, USA. gregory.r.scott@kp.org
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Scott
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Carson
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Borah
mesh_terms: D000293:Adolescent; D000368:Aged; D000556:Ambulatory Surgical Procedures; D001940:Breast / Q000473:pathology; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome