Macromastia and Reduction Mammoplasty: Analysis of Total Cost of Care and Opioid Consumption at 10-Years Post-Operatively

Goals/Purpose: Reduction mammaplasty is commonly performed with over 100,000 procedures annually. Despite a persistent number of patients with macromastia desiring reduction mammaplasty, insurance companies are less willing to pay for the operation. Macromastia has also been associated with increased opioid consumption. The purpose of this study was to evaluate total cost-of-care and opioid consumption in patients with macromastia and compare those who underwent reduction mammoplasty versus those that did not have surgery.

Methods/Technique: PearlDiver, a national database encompassing private payers with fifty-three million unique patients, was queried from 2010-2020. Patients with macromastia and those who underwent reduction mammaplasty were included utilizing International Classification Codes 9 and 10 and Current Procedural Terminology codes. Total cost-of-care and morphine milligram equivalents were calculated up to 10-years post-operatively for both cohorts. Cohorts were matched based on age, obesity and Charlson Comorbidity Index, and comparative statistics were calculated using t-tests.

Results/Complications: Of the 333,854 patients diagnosed with macromastia, 48,348 underwent reduction mammoplasty. Total cost-of-care one year after diagnosis of macromastia among patients who underwent reduction mammoplasty was higher compared to those that did not (Table 1). At 6 through10 years, there was no significant difference in total cost-of-care between the two cohorts. At every successive follow-up beyond 30 days post-operatively, macromastia patients not receiving reduction mammaplasty had a statistically significant higher morphine milligram equivalents consumption (Table 2).

Conclusion: Patients with macromastia who undergo reduction mammaplasty have less opioid consumption compared to patients that do not undergo reduction mammaplasty, with no long-term increases in total cost-of-care.