Breast reduction surgery helps women

ROCHESTER, MINN. — A review and meta-analysis of 29 studies involving more than 4,000 patients found that breast reduction surgery significantly improves the physical symptoms and quality of life in large-breasted women.

The surgery, known as reduction mammoplasty, was found to decrease back, neck and shoulder pain, headache, breast pain and numbness and pain of the hands. The study’s findings and an editorial on the subject appear in the May issue of Mayo Clinic Proceedings.

While third-party payers have usually deemed the procedure medically necessary if at least 350 grams of tissue per breast is removed, some insurance companies only provide reimbursement if patients are no more than 10 percent above their ideal body weight. The study authors wrote that a patient’s breast size in relation to her body proportion also frequently plays a significant role in physical symptoms, however, so body weight and breast tissue resection weight may not be adequate indicators of improved outcomes after reduction mammoplasty.

The study’s authors were: Elenie Chadbourne, M.D., Shuhuan Zhang, M.S., Matthew Gordon, B.A., Eric Ro, B.A., and Susan Ross, M.D. FRCPC, all of MetaWorks Inc., of Medford, Mass.; Paul Schnur, M.D., of Mayo Clinic Scottsdale (Ariz.); and Petra R. Schneider-Redden, M.D., of the American Society of Plastic Surgeons of Arlington Heights, Ill. The study reviewed literature in five languages from 1985 to March 1999. While the study was supported in part by the American Society of Plastic Surgeons, the study’s authors note that the review was carried out by scientists who were not plastic surgeons, thus reducing likelihood of bias in selecting studies, extracting data and interpreting results.

In an editorial, John E. Woods, M.D., Ph.D., of Mayo Clinic, and Robert M. Goldwyn, M.D., of Brookline, Mass., write that third-party payers have been reluctant to provide coverage, claiming that the reason for the operation is cosmetic and not therapeutic. While that may be true for a few patients, it’s not true for the majority, the editorialists write.

"In this study, ample data support the claim that this is a procedure of health benefit to the patients involved," Drs. Woods and Goldwyn write. "We believe the magnitude of the effect on the signs and symptoms pre- and postoperatively with this procedure is sufficiently well documented to be convincing."

Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.