From the Adolescent Breast Center and Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School.
Plast Reconstr Surg. 2024 Sep 1;154(3):421e-429e. doi: 10.1097/PRS.0000000000011083. Epub 2023 Sep 25.
Although the Schnur Sliding Scale (SSS) was not intended to be used by third-party payors, it has become the national standard for coverage decisions regarding macromastia treatment in patients of all ages. Adolescents were neither included in the cohort that created the SSS nor represented in subsequent validation studies.
In this prospective study, health-related quality of life surveys were administered to girls and young women 12 to 21 years of age before and after reduction mammaplasty to treat macromastia. The SSS was used preoperatively to estimate the amount of tissue to be resected. Before and after surgery, participants completed the Short Form-36, version 2 (SF-36); the Rosenberg Self-Esteem Scale (RSES); the Breast-Related Symptoms Questionnaire (BRSQ); and the Eating Attitudes Test-26. Demographic data were compared, and linear regressions were used to evaluate the effect of resection amounts meeting the SSS value on survey scores.
Resection amounts fell below the SSS for 39 patients and above the SSS for 255 patients. The 2 groups had no differences in mean age or body mass index. Both groups had significant postoperative survey score improvements on the RSES, BRSQ, and 7 of 8 SF-36 domains (all P < 0.05). The groups had comparable postoperative survey scores on the RSES, BRSQ, and 8 of 8 SF-36 domains (all P > 0.05).
Adolescents undergoing reduction mammaplasty above and below the SSS experienced comparable physical and psychosocial benefits. These findings underscore the need for third-party payors to broaden coverage for adolescent reduction mammaplasty, as the common coverage cutoff has no effect on overall postoperative benefit.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
尽管 Schnur 滑动量表(SSS)并非专为第三方付款人设计,但它已成为所有年龄段巨乳症治疗覆盖决策的国家标准。在创建 SSS 的队列中既没有包括青少年,也没有在随后的验证研究中代表他们。
在这项前瞻性研究中,对 12 至 21 岁的女孩和年轻女性进行了健康相关生活质量调查,这些女性接受了乳房缩小术以治疗巨乳症。术前使用 SSS 估计要切除的组织量。在手术前后,参与者完成了简短形式 36 项,第二版(SF-36);罗森伯格自尊量表(RSES);乳房相关症状问卷(BRSQ);和饮食态度测试-26。比较了人口统计学数据,并使用线性回归来评估符合 SSS 值的切除量对调查评分的影响。
39 名患者的切除量低于 SSS,255 名患者的切除量高于 SSS。两组的平均年龄或体重指数没有差异。两组在 RSES、BRSQ 和 8 个 SF-36 领域中的 7 个领域(所有 P <0.05)的术后调查评分均有显著改善。两组在 RSES、BRSQ 和 8 个 SF-36 领域中的术后调查评分相当(所有 P > 0.05)。
接受 SSS 以上和以下乳房缩小术的青少年经历了相当的身体和心理社会获益。这些发现强调了第三方付款人拓宽青少年乳房缩小术覆盖范围的必要性,因为常见的覆盖截止点对整体术后获益没有影响。
临床问题/证据水平:风险,II。