Schnur P L, Schnur D P, Petty P M, Hanson T J, Weaver A L
Division of Plastic and Reconstructive Surgery, Mayo Clinic Scottsdale, Ariz, USA.
Plast Reconstr Surg. 1997 Sep;100(4):875-83. doi: 10.1097/00006534-199709001-00008.
Outcome studies of the value of reduction mammaplasties have only recently appeared in the literature. Medical directors of insurance companies and managed care plans have been reluctant to pay for reduction mammaplasties, citing the uncertainty of the medical necessity of the procedure. They have defended their position by stating that the medical literature is devoid of studies documenting that reduction mammaplasty is medically beneficial to the patient. For this reason, reduction mammaplasty is often excluded from health care benefit plans. Because of the need for outcome studies for this procedure, the charts of 363 consecutive patients who had reduction mammaplasty at the Mayo Clinic from January of 1986 to December of 1993 were reviewed. Questionnaires were sent to all these patients asking them to evaluate their outcome, and 328 responded (90.4 percent response rate). Of the respondents, 94.2 percent believed that the procedure was completely or very successful, and only 1.5 percent believed that it was not very successful or completely unsuccessful. The symptoms most frequently reported by patients preoperatively were as follows: uncomfortable feeling about their body, 97.0 percent: inability to find clothes that fit, 95.7 percent; pain in bra-strap groove, 92.4 percent; shoulder pain, 86.0 percent; inability to run, 79.3 percent; upper back pain, 79.0 percent; inability to participate in sports, 77.4 percent; neck pain, 70.7 percent; lower back pain, 64.0 percent; and intertrigo, 61.0 percent. The symptoms least frequently reported by patients preoperatively were as follows: pain or numbness in the hands, 22.6 percent; headaches, 30.2 percent; arm pain, 35.4 percent; and breast pain, 58.2 percent. These symptoms were either relieved or partially relieved in 88 percent or more of the patients. Of the 328 patients, 97.3 percent responded that they definitely or probably would have the procedure again, and only 1.2 percent definitely or probably would not have the operation again. Evaluation of medical treatment used to relieve symptoms showed a marked decrease in the need for such measures after reduction mammaplasty. Study of the charges for the procedure revealed that the setting of practice parameters for the procedure and the use of an ambulatory surgery center significantly decreased the charges for the procedure. This outcome study supports the hypothesis that reduction mammaplasty is an effective procedure and the treatment of choice for symptomatic mammary hyperplasia.
关于缩乳术价值的疗效研究直到最近才出现在文献中。保险公司和管理式医疗计划的医学主管一直不愿为缩乳术付费，理由是该手术的医疗必要性存在不确定性。他们通过指出医学文献中缺乏证明缩乳术对患者有医疗益处的研究来捍卫自己的立场。因此，缩乳术常常被排除在医疗福利计划之外。由于需要对该手术进行疗效研究，我们回顾了1986年1月至1993年12月在梅奥诊所连续接受缩乳术的363例患者的病历。我们向所有这些患者发送了问卷，要求他们评估手术效果，有328人回复（回复率为90.4%）。在回复者中，94.2%的人认为手术完全成功或非常成功，只有1.5%的人认为手术不太成功或完全不成功。患者术前最常报告的症状如下：对自己身体的不适感，97.0%；找不到合身的衣服，95.7%；胸罩肩带处疼痛，92.4%；肩部疼痛，86.0%；无法跑步，79.3%；上背部疼痛，79.0%；无法参加运动，77.4%；颈部疼痛，70.7%；下背部疼痛，64.0%；以及擦烂，61.0%。患者术前最少报告的症状如下：手部疼痛或麻木，22.6%；头痛，30.2%；手臂疼痛，35.4%；以及乳房疼痛，58.2%。这些症状在88%或更多的患者中得到缓解或部分缓解。在328例患者中，97.3%的人回复说他们肯定或可能会再次接受该手术，只有1.2%的人肯定或可能不会再次接受手术。对用于缓解症状的医疗治疗的评估显示，缩乳术后此类措施的需求显著减少。对该手术费用的研究表明，可以通过设定该手术的操作参数以及使用门诊手术中心来显著降低手术费用。这项疗效研究支持了缩乳术是一种有效手术且是有症状乳腺增生的首选治疗方法这一假设。
