Breast Reduction Surgery and Quality of Life and Clinical Outcomes

Abstract:

Breast hypertrophy is a common condition seen by plastic surgeons. Patients with this condition complain of upper back, neck and shoulder discomfort and sometimes chronic headaches. They also have trouble finding proper clothing and have difficulties participating in sport activities. Therefore, this condition carries important burdens in health-related quality of life (HRQL). Breast reduction surgery is the solution to this problem. However, this procedure remains controversial in some geographic jurisdictions because third party payers refuse to pay for it. Also, rather arbitrarily, some plastic surgeons refuse to perform this surgery on overweight patients with this condition. This chapter provides an up-to-date review of the breast reduction studies in which quality of life was the primary outcome measure. The studies considered in this review covered the spectrum of the level of evidence, from case series to systematic reviews. The majority of publications, however, fell into the lower levels of the evidence (i.e., cohort and case control studies). All published studies, irrespective of study design demonstrated substantial improvements in quality of life in women who undergo breast reduction surgery. The recent evidence suggests that overweight patients with breast hypertrophy benefit from breast reduction just as much as thin patients with breast hypertrophy. Additionally, the mean quality-adjusted life years (QALY) gained per patient because of the surgery was 0.12 during the 1-year follow-up period. The health-related quality-of-life (HRQL) effect of the surgery translates into an expected lifetime gain of 5.32 QALYs, which is equivalent to each patient living an additional 5.32 years in perfect health.