General health status after breast reduction surgery – Tips from Other Journals
Anne D. Walling
Breast reduction surgery has frequently been criticized as being primarily a cosmetic procedure. Such criticisms may lead to the restriction of these surgeries in resource-conscious health systems. Although most patients seek surgery because of pain syndromes, studies confirm the clinical impression that patients report psychologic and quality-of-life improvements following breast reduction procedures. Klassen and colleagues attempted to document the changes in general health status of women following breast reduction surgery as part of the debate in Great Britain concerning the continuation of this surgery as part of the National Health Service.
The investigators surveyed 166 patients referred to three plastic surgery departments for this procedure. The patients were asked to complete standardized and validated health questionnaires before surgery and again six months following the procedure. Patients’ responses were compared with those of a random sample of women from the same geographic area and age group.
The 128 women for whom complete data were available had a mean age of 30.5 years (age range: 16 to 64 years). Both patients and their referring physicians predominately referred to physical symptoms as primary indications for surgery, although social and psychologic issues were also important. Before surgery, patients reported significantly poorer health than women in the control group on all eight of the dimensions of the assessment instrument (including aspects of social and physical functioning, energy, pain and mental health). When surveyed six months following surgery, the patients showed moderate to great improvement in all dimensions. The greatest gain was in reduction of pain, followed by increase in physical function, and improved social and psychologic functioning. The proportion of patients, with psychiatric disturbance assessed by the questionnaires fell from 41 percent preoperatively to 11 percent at follow-up. Patients reported a high degree of satisfaction with the change in their appearance.
The authors conclude that breast reduction surgery had a positive effect on the health and functional status of these women, in addition to a cosmetic value. They argue against resource allocation decisions that underestimate the total potential benefit to health and functional status from such surgeries.
Klassen A, et al. Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment: postal questionnaire survey. BMJ 1996;313:454-7.
EDITOR’S NOTE: This study cannot be used as definitive evidence that breast reduction surgery will benefit symptomatic patients. The British system is designed to discourage referrals for this type of procedure; hence the women in this study are a highly selected group of those with the most serious complaints or those with the most determination or ability to work through the system. For several reasons, direct comparisons with the overall population may not be valid. In particular, no matching was attempted for body mass index. In addition, the authors offer no explanation of why only 58 completed the follow-up questionnaire, compared with 128 who participated in the preoperative survey. The missing patients could have declined to complete the follow-up for many reasons, including disappointment with the results of surgery. Because family physicians are increasingly involved in patient requests for breast reduction surgery, it is important to recognize the limitations of the evidence on which decisions are made.
COPYRIGHT 1997 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group