American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty

Abstract

Summary: A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.

Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty

“…In regard to infection prophylaxis, the current American Society of Plastic Surgeons reduction mammoplasty guidelines advocate for the use of preoperative antibiotics in response to the finding by Ahmadi et al, who discovered that patients receiving preoperative antibiotics had a reduced risk of delayed wound healing, and this in turn was associated with lower infection rates. 6,24 This may be of even greater importance in the obese pediatric population due to their heightened risk of SSI. Additionally, these findings could inform guidelines and protocols for pediatric reduction mammoplasty, emphasizing the need for a nuanced approach to patient selection and management based on individual risk profiles.…”

“…5 Among these procedures, pediatric reduction mammoplasty has gained increasing prominence, reflecting both the evolving landscape of adolescent health and the challenges posed by the obesity epidemic. 6 Reduction mammoplasty aims to alleviate symptoms associated with macromastia, which has been shown to cause immense physical and psychological burden. 7 These symptoms may include pain, intertriginous dermatitis, restrictive respiratory effort, self-esteem issues, limitations on activity participation, and others.…”

“…13 Therefore, a thorough analysis of the risk in obese children and adolescents is necessary to ensure that these patients are not denied access to extremely beneficial plastic surgery. 6 Amid the complex interplay of sociocultural, genetic, and environmental factors contributing to the rise in pediatric obesity, the need to scrutinize the safety profile of interventions such as reduction mammoplasty becomes paramount. 14 This research seeks to fill a crucial knowledge gap by conducting an in-depth analysis of the outcomes of pediatric reduction mammoplasty, with a specific focus on the relationship between obesity and postoperative complications.…”

“…The burgeoning prevalence of pediatric obesity has given rise to a parallel surge in surgical interventions aimed at addressing obesity-related issues in adolescents 5 . Among these procedures, pediatric reduction mammoplasty has gained increasing prominence, reflecting both the evolving landscape of adolescent health and the challenges posed by the obesity epidemic 6 …”

Preauthorization Inconsistencies Prevail in Reduction Mammaplasty

“…1,2 For example, although the recently updated American Society of Plastic Surgeons Evidence-Based Clinical Practice Guidelines state there is strong evidence to offer reduction mammaplasty surgery as the first-line therapy over nonoperative modalities based on the presence of multiple symptoms alone, many patients are required to trial nonoperative therapy before obtaining insurance coverage. 3 In addition to these inconsistencies, there is a variability among the medical necessity criteria across major insurance providers, creating difficulties for patients, surgeons, and administrative staff. 2 In some cases, patients resort to switching insur-Medical necessity criteria policies have become increasingly stringent, albeit divergent among insurance companies.…”