Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA.
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA.
J Plast Reconstr Aesthet Surg. 2021 Oct;74(10):2537-2549. doi: 10.1016/j.bjps.2021.03.032. Epub 2021 Mar 30.
Patients undergoing breast reduction mammoplasty for symptomatic macromastia have a significantly improved quality of life postoperatively. However, there are no data that examine the effect of reduction mammoplasty on quality of life as a function of the weight of tissue removed. Because the process by which insurance providers consider patients' candidacy for this breast reduction mammoplasty is most often based on the proposed weight of tissue to be removed, this gap in our understanding is particularly glaring. We therefore designed a prospective trial with the intent of investigating the correlation between breast reduction specimen weight and postoperative pain and quality of life.
After obtaining institutional review board (IRB) approval, patients presenting for breast reduction mammoplasty at a single academic medical center between January 2016 and September 2019 were prospectively enrolled in the study. Study participants completed the Numerical Pain Rating Scale (NPRS), the short-form McGill Pain Questionnaire (SF-MPQ), and the BREAST-Q at set time points (preoperatively, 1 week/1 month/3 months/6 months postoperatively). Patients were divided into three cohorts based on breast reduction specimen weights: small (<500 g reduction), intermediate (500-1000 g reduction), and large (>1000 g reduction). The surveys were then analyzed while controlling for demographic factors and complications.
A total of 85 women were enrolled in the study and completed pre- and postoperative surveys (small reduction n = 21 (25%), intermediate n = 45 (53%), and large n = 19 (22%)). Regardless of reduction specimen weight, patients reported decreased overall pain and increased satisfaction with their breasts, as well as improved psychosocial, sexual, and physical well-being at each postoperative visit. Preoperative SF-MPQ pain scores were significantly lower in the small specimen weight group compared with either the intermediate or the large group (p = 0.001). Postoperatively, both the intermediate and large groups reported significant improvement in pain at each time point. The small specimen weight group did not report significant pain improvement until 3 months postoperatively.
Patients undergoing breast reduction mammoplasty experience decreased pain and improved quality of life regardless of reduction specimen weight. Improvement in these parameters manifests as early as 1 week postoperatively and maintained at 3 months postoperatively. These data suggest that many patients who are denied coverage for reduction mammoplasty on the basis of low projected reduction specimen weight would derive significant benefit from the procedure.
患有症状性巨乳症并接受乳房缩小成形术的患者术后生活质量显著改善。然而，目前尚无数据表明乳房缩小成形术对生活质量的影响与切除组织的重量有关。由于保险公司评估患者接受这种乳房缩小成形术的资格的过程通常基于拟切除的组织重量，因此我们对这方面的理解存在明显差距。因此，我们设计了一项前瞻性试验，旨在研究乳房缩小标本重量与术后疼痛和生活质量之间的相关性。
在获得机构审查委员会 (IRB) 批准后，2016 年 1 月至 2019 年 9 月期间，在一家学术医疗中心就诊的接受乳房缩小成形术的患者被前瞻性纳入研究。研究参与者在设定的时间点（术前、术后 1 周/1 个月/3 个月/6 个月）完成数字疼痛评分量表 (NPRS)、简短 McGill 疼痛问卷 (SF-MPQ) 和 BREAST-Q。根据乳房缩小标本的重量将患者分为三组：小 (<500g 减少)、中 (500-1000g 减少) 和大 (>1000g 减少)。然后，在控制人口统计学因素和并发症的情况下，对调查结果进行分析。
共有 85 名女性入组并完成了术前和术后调查（小切除组 n=21 (25%)，中切除组 n=45 (53%)，大切除组 n=19 (22%)）。无论缩小标本的重量如何，患者在每次术后就诊时都报告整体疼痛减轻，对乳房满意度提高，并且心理社会、性和身体幸福感得到改善。术前 SF-MPQ 疼痛评分在小标本重量组明显低于中或大标本重量组 (p=0.001)。术后，中间组和大组在每个时间点都报告疼痛明显改善。小标本重量组直到术后 3 个月才报告疼痛显著改善。
接受乳房缩小成形术的患者无论缩小标本的重量如何，疼痛都减轻，生活质量都提高。这些参数的改善早在术后 1 周就出现，并在术后 3 个月保持。这些数据表明，许多因预期缩小标本重量低而被拒绝接受乳房缩小成形术的患者将从该手术中获得显著益处。
