Longevity of Outcomes Following Reduction Mammoplasty

Preoperative and perioperative analyses

In total, 176 eligible patients were contacted by the phone for participation. Fifty of these (29.5%) patients declined to participate in the survey; 124 patients (70.5%) who were contacted completed the survey. All completed surveys were included in the statistical analysis. The mean age of patients at the time of surgery was 38.5 years (SD = 13.7 years) and ranged from 17 to 71 years of age. All patients reported physical symptoms prior to surgery, which included back pain, bra strap shoulder grooving, intertrigo, posture problems, and breathing difficulties (Table 2). The most common symptoms were back pain and shoulder grooving.

Long-term postoperative outcomes

Postoperative outcomes were assessed and are displayed in Table 3. Roughly one-third (31%) of all patients reported having abnormalities on mammography. However, only 3 patients reported malignant diagnoses from subsequent workup. All 3 patients subsequently underwent appropriate breast cancer treatment including mastectomy. Only 20 patients (16%) had children after their reduction mammoplasty, 6 (30%) of whom reported that they were able to breastfeed.

The patients were then divided into subgroups according to their length of follow-up: 5, 10 and 15 years postprocedure. The majority of patients in all 3 groups reported that macromastia symptoms were completely or mostly resolved after surgery (75% vs 82% vs 82%, P = .840). In the 5-year group, 19% of people reported residual symptoms compared with 36% of people in both the 10- and 15-year groups, although this did not reach significance (P = .100). A larger proportion of patients 10 (45%) and 15 (43%) years out from surgery reported return of symptoms compared with those 5 (19%) years out from surgery; however, this difference was not statistically significant (P = .36). There was a significant difference in the proportions of patients in all 3 groups who reported an increase in breast size since surgery (40% vs 70% vs 51%, P = .0297). Similarly, there was a difference in proportions of patients who reported an increase in body weight between all 3 groups (13% vs 42% vs 41%, P = .0017). Interestingly, patients in all 3 groups reported improved exercise tolerance after surgery but no group benefitted more than the others (63% vs 55% vs 74%, P = .215).

There was a significant difference in the proportion of patients who reported decreases in nipple sensation: 31%, 36%, and 54% of people reported decreased nipple sensation in the 5-, 10-, and 15-year groups, respectively (P = .0416). Only 8 people in the study (4.5%) had additional breast surgeries after their reduction mammoplasty. Only 2 patients in the study (1.6%) reported that they had undergone a subsequent reduction mammoplasty after the initial procedure. Both patients attributed recurrent macromastia symptoms to weight gain after the first surgery.

Satisfaction

Multiple questions in the survey also addressed patient satisfaction after reduction mammoplasty (Table 4). In all 3 groups, more than 90% of participants reported that they were happy with the reduction mammoplasty (93% vs 91% vs 91%, P = .914). In the 5-year group, 90% had no regrets with the surgery compared with 79% in the 10-year group and 77% in the 15-year group, but this was not significant (P = .181). When asked whether they would want another reduction mammoplasty, only 17% to 24% of participants indicated that they would want another reduction, with no significant differences among the 3 groups (P = .689).

To further quantify satisfaction, participants were asked to rank their overall and aesthetic satisfaction after surgery using a 5-point Likert scale with 2 verbal anchors (1 was the least satisfied and 5 most satisfied). In the 5-year group, the median overall satisfaction was 4.5; in the 10-year and more than 15-year groups, overall satisfaction was 4 and 4, respectively. Median values for aesthetic satisfaction were 4, 5, and 4 for the 5-, 10-, and 15-year group, respectively. Overall, patient satisfaction after reduction mammoplasty was high and did not significantly decrease over time.

Limitations

Although this retrospective study provides insight into the long-term effects of reduction mammoplasty, it does have limitations that include recall bias and use of a retrospective, nonvalidated survey. Errors in recall may be more prevalent as time has elapsed since surgery. Furthermore, our study only assesses postoperative patient satisfaction. Prior studies compare preoperative survey results with postoperative results.^5,10,11,15 Because of the retrospective nature of this review, we did not have the opportunity to survey patients prior to their surgeries. Thus, all results are based on the patients’ recollection of their quality of life and symptoms before and after surgery. Nevertheless, patients’ perceptions remain one of the most important measures of surgical outcomes.

Several studies investigating patient-reported outcomes after reduction mammoplasty have been conducted using the BREAST-Q.¹¹ We chose to implement a novel, focused survey with questions specifically tailored to evaluate long-term symptom relief and satisfaction following reduction mammoplasty. The survey was designed to be brief so that it could be effectively administered over the phone to maximize completion rate and targeted responses. Although our questionnaire has not been formally validated, it provided a focused and practical instrument to evaluate patient satisfaction following reduction mammoplasty for the purpose of this study. In addition to symptom relief and satisfaction that are addressed on instruments such as the BREAST-Q, it evaluates patient-reported functional outcomes such as change in exercise tolerance. With these limitations in mind, this study adds to the literature as a concise custom study to allow for greater participation, collection of more specific data, and ease of execution, while showing the longevity of patient satisfaction for more than 15 years.

We also acknowledge the possibility of selection bias, as records of those with more historic surgeries are stored on paper charts or older electronic chart systems and are thus less easily retrieved. We did not have the ability to collect data of BMI, surgical technique, and postoperative complications because many of the surgeries occurred more than 10 years ago and these paper records have either not captured these data or records could not be accessed. Future studies could investigate the relationship of these factors with patient satisfaction.