Prospective Study of Outcomes after Reduction Mammaplasty
Brian J. Miller, MD, Steven F. Morris, MD, Leif L. Sigurdson, MD, Richard L. Bendor-Samuel, MD, Mike
Brennan, MD, George Davis, MD, and Justin L. Paletz, MD.
Macromastia is commonly associated with physical symptoms including neck, back, shoulder and breast pain,
painful bra strap grooving, intertrigo, poor posture and difficulty exercising. It is also often associated with
psychological symptoms related to unwanted attention, difficulty finding clothing that fits and low self-esteem.
Reduction mammaplasty is widely accepted by plastic surgeons as an effective means of relieving many of these
symptoms.
Several studies have concluded that reduction mammaplasty benefits women with macromastia. Many of these
studies were retrospective or did not make use of validated measures of health status.1-7 More recent studies have
been prospective and have made use of validated outcomes tools, such as the Short Form-36 Health Survey (SF36).8-14 The patient populations described by these studies may not be comparable to our patient population due to
regional variation in the ways women are selected for reduction mammaplasty. For example, pre-approval for
surgery is required in some provinces based on factors such as body mass index (BMI).
A prospective study of outcomes after reduction mammaplasty was designed in order to assess the effectiveness
of reduction mammaplasty in our patient population, to compare preoperative and postoperative health status to
the normal population, and to eventually examine the role of BMI and amount of reduction as predictors of
outcome after reduction mammaplasty.
Methods: Patients were enrolled prospectively by six participating surgeons. Surgeons completed a preoperative
assessment form documenting height, weight and physical exam findings for each patient. Surgeons also
completed an operative note form, as well as postoperative assessment forms at 1 and 6 months after surgery
describing the postoperative course, length of hospitalization, time of return to work and complications. Patients
completed three health questionnaires preoperatively and again 6 months postoperatively to assess health status
before and after surgery. These consisted of the Short Form-36 Health Survey (SF-36), the Rosenberg SelfEsteem Scale, and the Symptom Inventory Questionnaire - a questionnaire describing the presence and severity of
breast related symptoms. SF-36 scores before and after surgery were compared to previously published Canadian
normative data.15 Demographic data was also collected.
Results: Preoperatively, the most common bra cup size was DD (56%). Average BMI was 29.8 kg/m2. Breast
pain on palpation was uncommon (4.3%), and shoulder grooving was almost always present (96%). The inferior
pedicle technique was used most often (96%). Liposuction was occasionally performed at the time of reduction
mammaplasty (13%). Drains were used in almost all cases (96%). Prophylactic antibiotics were used most of the
time (74%). There were no intraoperative problems reported. The average hospital stay was 0.85 days. Average
time until return to work was 26.4 days. The most common complication reported was delayed wound healing
(19%). The majority of patients were employed full-time (56%), married (60%) and Caucasian (98%). Mean age
was 40 yrs. Household income and education were varied.
Comparison of mean preoperative and postoperative SF-36 scores showed significant improvements in seven out
of eight health domains and in the physical health summary scale (p<0.01) (Fig. 1). Significant improvements
were also seen in mean scores on the Rosenberg Self-Esteem Scale (p<0.001). The Symptom Inventory
Questionnaire demonstrated significant improvements in all breast related symptoms (p<0.01) and no significant
change in nipple sensation or pain (p>0.05).
When compared to previously published norms for the age-matched female population, mean preoperative SF-36
scores were significantly worse in the physical functioning, bodily pain and vitality domains, as well as on the
physical health summary scale (p<0.0002). Mean scores for the remaining domains and the mental health
summary scale were not statistically different than the normal population (p>0.05) (Fig. 2). Postoperatively, none
of the SF-36 scores were significantly lower than population norms. Patients scored significantly higher than the
normal population on the role physical, vitality, social function and mental health domains (p<0.05) (Fig. 3).
Conclusion: Reduction mammaplasty was effective in relieving the symptoms commonly associated with
macromastia. Rosenberg Self-Esteem Scale and SF-36 scores demonstrated a significant improvement in health
status at 6 months after surgery. When compared to the normal population, SF-36 scores indicated that patients
had a significant health deficit preoperatively and normalized at 6 months after surgery. The physical and mental
health summary scales suggest that the preoperative burden and postoperative improvement is related more to
physical health than to mental health.
Further follow-up is required to determine whether this improvement persists over time. Enrollment of more
patients will provide adequate numbers to allow for subgroup analysis based on BMI and amount of reduction in
order to determine whether these factors are important in predicting outcome after reduction mammaplasty.
100
*
*
*
90
*
Mean
SF-36
Scores
*
*
80
*
70
Preop.
Postop.
60
*
50
40
PF
RP BP GH V SF RE MH PHS MHS
SF-36 Domains and Summary Scales
Fig 1. Comparison of mean preoperative and postoperative SF-36 scores. * = p<0.01. PF = physical function,
RP = role physical, BP = bodily pain, GH = general health, V = vitality, SF = social function, RE = role
emotional, MH = mental health, PHS = physical health summary scale, MHS = mental health summary scale.
2SD
1SD
Mean
Preoperative
SF-36 Scores
Relative to
Population
Norms (N)
N
*
-1SD
*
*
*
-2SD
PF RP BP GH
V
SF RE MH PHS MHS
SF-36 Domains and Summary Scales
Fig 2. Comparison of mean preoperative SF-36 scores to age and gender matched population norms.
* = p<0.0002. PF = physical function, RP = role physical, BP = bodily pain, GH = general health, V = vitality,
SF = social function, RE = role emotional, MH = mental health, PHS = physical health summary scale, MHS =
mental health summary scale.
2SD
1SD
Mean
Postoperative
SF-36 Scores
Relative to
Population
Norms (N)
*
*
*
*
N
-1SD
-2SD
PF RP BP GH V
SF RE MH PHS MHS
SF-36 Domains and Summary Scales
Fig. 3. Comparison of mean postoperative SF-36 scores to age and gender matched population norms.
* = p<0.05. PF = physical function, RP = role physical, BP = bodily pain, GH = general health, V = vitality, SF =
social function, RE = role emotional, MH = mental health, PHS = physical health summary scale, MHS = mental
health summary scale.
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