title: Quality of Life and Alleviation of Symptoms After Breast Reduction for Macromastia in Obese Patients: Is Surgery Worth It?
abstract: BACKGROUND
  Breast hypertrophy can cause a variety of symptoms and affect lifestyle and quality of life. Breast reduction, being the most effective treatment, is sometimes difficult to establish as standard treatment in obese patients (difficulties to differentiate symptoms from macromastia or from obesity, higher rate of complications).
  
  
  OBJECTIVE
  To evaluate the effect of reduction mammaplasty (quality of life and symptoms) in obese patients comparing with non-obese.
  
  
  METHODS
  This is a prospective study of patients undergoing reduction mammaplasty. Patients were allocated in non-obese (BMI < 29) and obese (BMI > 30). Demographic data, comorbidities, specific symptoms questionnaire, data from the surgical procedure, Spanish version of the Health-Related Quality of Life (SF-36) questionnaire, complications and sequels were recorded and collected before the operation and at 1 month and 1 year after. Chi-square, Fisher's exact t test, McNemar, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis.
  
  
  RESULTS
  One hundred twenty-one consecutive patients were operated on; 54 (44.6 %) obese and 67 (55.4 %) non-obese. The average age of patients was 40.7 (18-78), average volume of resected tissue was 1.784 g (401-5.790), and average hospital stay was 2.94 days (1-11). There were no differences between obese and normal BMI patients with regard to length of hospital stay, complications, sequels, or reoperations. Symptoms improved in both groups. Physical and mental components of the SF-36 improved at 1 year in both groups (p < 0.001). The mental health component improved at 1 month (p < 0.001) in both groups.
  
  
  CONCLUSIONS
  Obese patients should be considered for reduction mammaplasty surgery in the same way as women of normal weight.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Surgery, University Hospital Zaragoza, Av. San Juan Bosco 15, 50009, Saragossa, Spain. aguemes@unizar.es.|Department of Surgery, University Hospital "Lozano Blesa", Av. San Juan Bosco 15, 50009, Saragossa, Spain. aguemes@unizar.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Güemes
authors.affiliation: Department of Surgery, University Hospital Zaragoza, Av. San Juan Bosco 15, 50009, Saragossa, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Pérez
authors.affiliation: Department of Surgery, University Hospital Zaragoza, Av. San Juan Bosco 15, 50009, Saragossa, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Sousa
authors.affiliation: Department of Surgery, University Hospital Zaragoza, Av. San Juan Bosco 15, 50009, Saragossa, Spain.
authors.forename: Ismael
authors.initials: I
authors.lastname: Gil
authors.affiliation: Department of Surgery, University Hospital Zaragoza, Av. San Juan Bosco 15, 50009, Saragossa, Spain.
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Valcarreres
authors.affiliation: Instituto de Investigación Sanitaria Aragón (IIS), Av. San Juan Bosco 13, 50009, Saragossa, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Carrera
authors.affiliation: Hospital Miguel Servet, Av. Isabel la Católica 1,3, 50009, Saragossa, Spain.
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Gracia
authors.affiliation: Department of Surgery, University Hospital Zaragoza, Av. San Juan Bosco 15, 50009, Saragossa, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Artigas
authors.affiliation: Facultad de Ciencias de la Salud, University of Zaragoza, C/Domingo Miral s/n, 50009, Saragossa, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Gascon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000209:etiology / Q000601:surgery*; D016462:Mammaplasty; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast hypertrophy; Obesity; Quality of life; Reduction mammaplasty; SF-36 questionnaire