Journal of Aesthetic & Reconstructive Surgery

Reduction Mammaplasty in Patients with Significant Asymmetry- An Assessment of Clinical and Patient Reported Outcomes

Background: The improvement in Patient-Reported Outcomes (PROs) gained by patients undergoing Reduction Mammoplasty (RM) for macromastia with marked asymmetry has not been characterized. We assessed clinical and PROs in women with marked preoperative breast asymmetry.

Methods: Patients with macromastia undergoing RM at an academic hospital were retrospectively identified (2016-2020). Those who completed pre- and postoperative BREAST-Q© questionnaires were included. Marked breast asymmetry was defined by the ratio of breast tissue excised between breasts > 75th percentile. Risk-adjusted logistic regression and generalized linear models were used to compare clinical outcomes and determine predicted mean differences in PRO BREAST-Q© scores, respectively.

Results: 105 patients were included: 75.2% symmetric, 24.8% asymmetric. Median age was 39 years and BMI 29.8 kg/m², 50.5% were Black, 74% had brassier cupsize ≥ DDD, undergoing a wise-pattern inferior pedicle RM (60%). The asymmetric group had a 27.4% (IQR 20.5–39.5%) The median difference of between breast tissues excised was higher for the asymmetric group (27.4% vs. 6.5%; p < 0.01). The overall complications and revisions did not differ (p > 0.05). Marked asymmetry was associated with lower baseline BREAST-Q© scores in the psychosocial, sexual, and physical well-being scales. Overall, PROs improved significantly for all RM patients (p < 0.05), with no significant differences in the relative improvement between cohorts (p > 0.05).

Conclusion: The macromastia burden is higher for patients with marked breast asymmetry. However, surgeons should be encouraged to achieve symmetric results irrespective of preoperative imbalances as clinical outcomes and the magnitude of PROs improvement are comparable despite differences in tissue excised among patients with macromastia.

Author(s):

Arturo J. Rios-Diaz1,2, Jessica R. Cunning1, Sameer Shakir1, Robyn Broach1, Omar Elfanagely1, Shelby Nathan1, Paris D. Butler1, and John P. Fischer1*

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