A Systematic Review of Breast-Q Outcomes Following Reduction Mammaplasty
Methods/Technique:
A comprehensive review of the literature was conducted to identify publications utilizing the BREAST-Q survey to evaluate patient satisfaction after reduction mammaplasty. The following search terms were used: (("breast q") OR ("breast-q")) AND ("Mammaplasty"[Mesh] OR mammoplast* OR mammaplast* OR (breast n3 reduc*)). Studies reporting pre-operative and/or post-operative BREAST-Q scores following reduction mammaplasty were included. The following data was recorded: study design, study size, incision type, pedicle used, mean age, mean BMI, race/ethnicity, smoking status, diabetes, history of bariatric surgery, bilateral vs. unilateral reduction, concurrent operations/procedures, pre-operative ptosis grade, pre-operative and post-operative cup size, mean resected weight, complication rate, length of follow-up, survey response rate, and mean BREAST-Q scores by category (Satisfaction with the Breasts, Psychosocial Well-Being, Sexual Well-Being, Physical Well-Being, Satisfaction with NAC, Satisfaction with Outcome, Satisfaction with Information by Plastic Surgeon, Satisfaction with Surgeon, Satisfaction with Medical Team, Satisfaction with Outpatient Staff).
Mean differences for pre-operative and post-operative scoring were determined. Univariate analysis was carried out comparing mean patient BMI, mean age, mean resected weight, complication rate, pedicle used (superomedial vs. inferior), and incision type (Wise pattern vs. vertical incision) against pre- and post-operative BREAST-Q scores. These factors were selected because they were eligible for statistical analysis. Linear regression and Spearman’s rank correlation coefficients (SRCC) with corresponding p-values were calculated for each of these variables with respect to BREAST-Q scores.
Results/Complications:
Literature search identified 378 unique articles, of which 14 met our inclusion criteria, yielding 4,337 patients with a survey response rate of 69.2%. The time between reduction and completion of the post-operative BREAST-Q scale ranged from <3 months post-operative to 12 months post-operative (8/14 studies). The length of follow-up time ranged from 6 weeks to 10 years post-operative (10/14 studies). Survey response rates ranged from 27.7% to 100% (12/14 studies). The overall mean age ranged from 15.8 to 55 years across study groups. Mean BMI ranged from 22.5 to 32.4 kg/m2. Bilateral mean resected weight ranged from 323 g to 1845.96 g. The overall complication rate was 19.9% (11/14 studies). Complications represented included a range of outcomes such as hematoma/seroma formation, unsatisfactory scar, asymmetry, dehiscence, wound infection, tissue necrosis, nipple loss, and one case of hypertensive pneumothorax.
Though data regarding surgical incision type and pedicle used for reconstruction were occasionally reported, most studies did not stratify BREAST-Q scoring by surgical technique, so direct comparisons were not feasible. The most commonly used incision types (11/14 studies) overall were Wise pattern reduction (74.9%), Regnault’s “B” technique (13.8%), and vertical (9.9%). The most commonly utilized pedicle (8/14 studies) was superomedial, accounting for 50.9% (532/1046) of operations that specified. The inferior pedicle was used 19.8% (207/1046) of the time.
On average, “Satisfaction with Breasts” increased 52.1 ± 0.9 points (p<.0001), “Psychosocial Well-Being” increased 43.0 ± 1.0 points (p<.0001), “Sexual Well-Being” improved 38.2 ± 1.2 points (p<.0001), and “Physical Well-Being” improved by 27.9 ± 0.8 points (p<.0001). Positive correlations were identified between mean age and pre-operative sexual well-being (+0.61, p<.05), BMI and post-operative satisfaction with breasts (+0.53, p<.05), and resected weight and post-operative satisfaction with breasts (+0.61, p<.05). Negative correlations were identified between BMI and pre-operative physical well-being (-0.78, p<.01). Superomedial pedicle usage was negatively correlated with post-operative physical well-being (-0.67, p<.05) while Wise pattern incisions were negatively correlated with post-operative sexual well-being (-0.66, p<.05) and physical well-being (-0.70, p<.05). Usage of a vertical incision appeared to be negatively correlated against satisfaction with the NAC post-operative (-0.78, p<.05). No significant correlations were noted with complication rates and inferior pedicle use. Most notably, none of the analyzed characteristics had a statistically significant correlation with the difference between pre-operative and post-operative BREAST-Q scores.
Conclusion:
Breast reduction surgery consistently and significantly improves patient outcomes according to the BREAST-Q. Although either pre-operative or post-operative scores may be individually influenced by BMI, resected weight, pedicle used, or incision type, these variables demonstrated no statistically significant effect on the average change of these scores. Taken together, the data suggests that breast reductions provide substantial improvement in patient-reported satisfaction regardless of any of these patient-specific or surgical factors.