Breast Reduction Mammoplasty Intraoperative Weight Versus Pathology Weight: Reimbursement Decline Based on Weight Discrepancy

Goals/Purpose: Reimbursement for bilateral reduction mammoplasty can be declined when there is a discrepancy in intra-operative versus pathology-measured weights. Over time the breast specimen can lose weight presumably due to dehydration from the time of surgery to the analysis by pathology. Insurance companies use the weight determined by the pathology department which can be lower than OR. The aim of this study was to assess the percentage of weight difference from intra-operative versus pathology measurement. 

Methods/Technique: This was a retrospective review of 58 breast reductions performed in 31 patients. Twenty-seven breast reductions were bilateral, while 4 were unilateral for symmetry breast reconstruction. Intra-operative weights were compared to weights obtained in pathology. All breast specimens were sent to pathology for analysis. Forty-eight of the breast reductions were performed with the inferior pedicle wise pattern, 6 with the superior medial pedicle vertical incision and 2 with the drape technique. 

Results/Complications: Intra-operative weights were always more or almost equal to those obtained by pathology. The percent difference of the intra-operative weight was calculated against the pathology weight. The range of weight difference from pathology was 55.1% to 99.8% of the intra-operative weight. The average of the pathology weight removed was 89.6+/-5.5% of the intra-operative weight of the specimen. Insurance reimbursement was declined in three bilateral reductions because of significant discrepancy in pathology weight versus intra-operative measurements. Complications in this series included 3 fat necrosis and 2 insensate nipples. None of these patients required repeat surgery for infection, wound dehiscence or hematoma. No cancer was reported in any of the specimens and there was no nipple loss in this series. 

Conclusion: Pathology measured breast reduction weights can be decreased from intra-operative weights by an average of 10-15%. Knowledge of this potential discrepancy can be used to prevent reimbursement controversies with breast reductions.