Breast Reduction Prior to Massive Weight Loss: Satisfaction with Current Breast Contour
Peter F. Koltz, MD, Michelle Coriddi, BS, Frank Albino, MD, Jeffrey A. Gusenoff, MD.
University of Rochester Medical Center, Rochester, NY, USA.
Reduction mammoplasty is one of the most common procedures performed by plastic surgeons, with over 88,000 performed in 2008, a 5% increase over the previous year. Similarly, bariatric surgery is gaining in popularity to treat morbid obesity, with a 10-fold increase in the past decade. After massive weight loss (MWL), breasts often deflate, with loss of upper poll fullness, projection, and shape. A certain number of patients seeking body contouring after MWL will have had a reduction mammoplasty prior to their bariatric procedure. Currently, it is unclear how weight loss affects breast reduction surgery outcomes and patient self-image with respect to breast size and shape. This study aims to explore the effect of MWL on patient satisfaction after reduction mammoplasty.
The surgical history of 190 consecutive MWL patients (>50lbs) presenting for body contouring surgery were examined from a prospective database. Patients undergoing breast reduction prior to MWL were selected and administered a phone survey about satisfaction with their body image, current breast contour, and desire for future revisional breast surgery. Patient demographics, co-morbidities, BMI indices, surgical history, and weight loss method employed were also evaluated. Descriptive and summary statistics were used to identify a central tendency.
15 patients (7.9%) underwent breast reduction prior to MWL. 9 completed the survey (60%) with a Max BMI=53.1(+/-12.2), BMI after breast reduction=43.2 (+/-8.6), Current BMI=29.4 (+/-7.2), and Lowest BMI after body contouring=27.9 (+/-6.5). Bra sizes ranges were: Max weight 40H to 60G, after reduction 36C to 46C, and after MWL 32A to 38D. 100% of patients felt the appearance of their breasts improved after breast reduction; however, all of the patients felt their breast appearance worsened after MWL. 89% of patients were able to exercise more and lose more weight on their own because of their breast reduction. 78% of patients wished their breasts currently looked different, with 22% desiring larger breasts, 11% desiring reduced breasts, 78% desiring lifted breasts, and 22% desiring general reshaping. 78% of patients wish they had MWL prior to breast reduction surgery and 100% of patients would recommend that a friend loses weight prior to breast reduction surgery. 78% of patients felt a secondary lift following MWL should be covered by insurance, and 56% plan on having revisional breast surgery. All patients not planning revisional breast surgery commented that they would if it was covered by insurance.
Conclusions: Most patients who undergo breast reduction prior to MWL are dissatisfied with their breast shape and contour following MWL. While breast reduction contributes to the patient’s ability to become more active following breast reduction, patients should be counseled that obtaining a BMI closer to their ideal BMI prior to reduction will likely optimize results. Those patients who are considering bariatric procedures should be encouraged to pursue that operation before proceeding with a reduction mammoplasty.
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