The selection of patients for breast reduction: should health commissions have a say?

Horlock, Nigel; Cole, Robert P.; Rossi, Alessio

doi:10.1054/bjps.1997.3052

Cited by 9 publications

(3 citation statements)

References 4 publications

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“…As a result, insurers do not accept that symptomatic macromastia is a significant health burden. Unfortunately, denials of insurance coverage and policy exclusions for breast reduction are becoming increasingly common in Europe as well as in the United States 15,18,19 and the justification for outright rejection of funding is often unknown 20 . Although previously published longitudinal studies showed that reduction mammoplasty will reliably provide the desired improvement of all symptoms and improvement in the quality of a women's life [1][2][3][4][5][6][7][8]13 , a continuous discussion is ongoing about whether reduction mammoplasty is a cosmetic or reconstructive procedure.…”

Section: Introductionmentioning

confidence: 99%

Hypertrophy of the Breast: A Problem of Beauty or Health?

Benditte-Klepetko

Leisser

Paternostro-Sluga

et al. 2007

Journal of Women's Health

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Section: Introductionmentioning

confidence: 99%

Hypertrophy of the Breast: A Problem of Beauty or Health?

Benditte-Klepetko

Leisser

Paternostro-Sluga

et al. 2007

Journal of Women's Health

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“…Previous attempts at rationing the provision of this procedure have met with severe criticism. For example, the requirement for psychological evaluation was seen by GPs and patients alike as a deterrent (Horlock et al , 1999).…”

Section: Discussionmentioning

confidence: 99%

The effect of new inclusion criteria on patient selection for reduction mammaplasty

Glass

Soldin²

2007

Clinical Governance: An International Journal

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PurposeTo evaluate the impact of rationing guidelines on the practice of reduction mammaplasty, with particular reference to patient selection.Design/methodology/approachA retrospective audit was performed. Patients who were accepted for surgery in the first nine months following the date of publication of new and explicit inclusion criteria were compared with patients who were accepted for surgery in the 15 months preceding publication.FindingsOf 131 consecutive patients, 98 were accepted before publication of the inclusion criteria, with 33 after. A total of the 97 of 98 and 33 of 33 were symptomatic. Conformity to criteria for body mass index (BMI) increased from 65 of 98 (66 per cent) to 25 of 33 (76 per cent, p=0.143) Attendance at pre‐operative breast seminar increased from 72 of 98 (73 per cent) to 29 of 33 (88 per cent, p=0.099). Incidence of smoking increased from 18 of 98 (18 per cent) to 7 of 33 (21 per cent, p=0.799). Patients under the age of 30 accounted for this increase. The number of cases who failed on more than one criterion fell from 17 of 98 (7 per cent) to 2 of 33 (3 per cent, p=0.155).Practical implicationsDemonstrates a non‐significant reduction in the number of obese patients being accepted for surgery, and a non‐significant increase in uptake of pre‐operative nurse led seminars in the practice. Since publication of the inclusion criteria, all but one of the patients accepted for surgery with exclusion criteria failed on the basis one criterion only. Not successful in enforcing abstinence from smoking as a condition for surgery, particularly among younger patients. To help do this objective ways to assess smoking status need to be looked at. A re‐audit is required to complete the loop.Originality/valueThis is the first paper to present audit results for the new inclusion criteria for reduction mammaplasty.

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“…Our study did not find greater improvement in health burden for those who met the Schnur criterion compared to those who did not. Al- though other investigators have studied quality of life and self-esteem in women with breast hypertrophy, 3,[19][20][21] none have used these tools to validate current definitions of medical necessity. Nevertheless, we cannot rule out the possibility that our results might be biased from some women having overstated their symptoms.…”

Section: Discussionmentioning

confidence: 99%

Reduction Mammaplasty: Defining Medical Necessity

et al. 2002

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The authors evaluated existing and new criteria for defining the medical necessity for breast reduction surgery. Two cohorts of women (those requesting breast reduction surgery [N = 266] and a group of controls [N = 184]) completed a questionnaire including breast-specific symptom severity, the Short Form 36, the EuroQol, the McGill Pain Questionnaire, and the Multidimensional Body Self Relations Questionnaire. To evaluate prediction validity, the most widely accepted decision criteria and a new definition of medical necessity were applied to the data set to determine whether women meeting the definition had more favorable outcomes than those who did not as measured by validated self-report instruments. For existing criteria, women not meeting and meeting the criterion gained equal benefit from surgery. Women meeting the new definition (> or = 2 of 7 physical symptoms all or most of the time) had significantly greater improvement scores on 4 of the 5 health burden measures compared to women not meeting this definition. The authors conclude that medical necessity for breast reduction surgery is better defined by self-report of symptoms than by existing criteria.

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The selection of patients for breast reduction: should health commissions have a say?

Cited by 9 publications

References 4 publications

Hypertrophy of the Breast: A Problem of Beauty or Health?

Hypertrophy of the Breast: A Problem of Beauty or Health?

The effect of new inclusion criteria on patient selection for reduction mammaplasty

Reduction Mammaplasty: Defining Medical Necessity

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