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The Underappreciated Benefit Of Breast Reduction: Quality Of Life Improvement After Reduction Mammoplasty
Said Azoury, MD, Arturo J. Rios-Diaz, MD, Jessica R. Cunning, MBA, Louis-Xavier Barrette, BS, Rotem Kimia, BA, Robyn B. Broach, PhD, Joseph M. Serletti, MD, Paris D. Butler, MD, MPH, John P. Fischer, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.

Purpose: Patient reported quality of life (QoL) coinciding with breast reduction for patients suffering with macromastia has yet to be defined. The objectives of this study were to (1) quantify the benefit of BR through the change in QoL, (2) determine preoperative factors affecting baseline QoL, and (3) determine whether postoperative complications affect the change in QoL in women undergoing BR for macromastia. We hypothesized that BR improves QoL and that there are preoperative characteristics as well as postoperative complications that affect QoL.
Methods: Patients who underwent breast reduction for macromastia between 2016-2019 were identified retrospectively. Patient reported QoL data was extracted from Breast-Q surveys that were administered at preoperative and postoperative visits. Descriptive statistics were used to analyze patient characteristics and clinical outcomes. For each preoperative Breast-Q survey domain, patients in the highest and lowest QoL tertiles were compared using Chi-square tests to determine patient characteristics and exam findings associated with low QoL. Kruskal-Wallis tests were used to determine the impact of postoperative complications (surgical site occurrences, emergency department visits, readmissions, reoperations and composite) on net QoL score change. Paired Wilcoxon signed-rank was used to compare the change in preoperative and postoperative QoL scores.
Results: Out of 163 women who underwent breast reduction, 129 (79%) completed preoperative Breast-Q surveys, while 90 (55%) completed both pre- and postoperative surveys. Among those who underwent surgery and had a preoperative Breast-Q, the median age was 37 (interquartile range [IQR] 27-49). The majority of patients were Black (51%), covered by insurance (89%), obese (54%), non-diabetic (93%), had grade-III ptosis (73%), cup-size >DD (71%) and experienced brassier notching (94%) and/or rash (75%). Most patients underwent breast reduction by the inferior pedicle technique (57%) and had drains placed (61%). The composite complication rate was 12%. The preoperative factors associated with low QoL are shown in the Table. Comparison of pre- and postoperative QoL scores showed significant improvement in the four domains assessed: breast satisfaction (pre: 23 [IQR 12-29] vs. post: 84 [72-100]), psychosocial well-being (pre: 37 [21-46] vs. post: 100 [77-100]), sexual well-being (pre: 35 [21-40] vs. post: 100 [67-100]), and physical well-being (pre: 42 [31-53] vs. post 83 [71-92]; all p<0.01). The QoL improvement in the physical well-being domain was negatively impacted by complications (net QoL change: postoperative complication 37 [28-50] vs. no complication 54 [35-63], p=0.04).
Conclusions: For patients with macromastia, preoperative QoL is negatively impacted by obesity, large breast size, and severe ptosis. The benefit of breast reduction on patient reported QoL should not be underappreciated as all four domains significantly improved postoperatively: 1) satisfaction with breasts, 2) psychosocial well-being, 3) sexual well-being, and 4) physical well-being. However, postoperative complications hindered the potential QoL improvement, highlighting where to concentrate future efforts in order to attain full QoL benefits.


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