Does breast reduction surgery improve health-related quality of life? A prospective cohort study in Australian women

Crittenden, Tamara; Watson, David I.; Ratcliffe, Julie; Griffin, Philip A; Dean, Nicola R.

doi:10.1136/bmjopen-2019-031804

Cited by 19 publications

(23 citation statements)

References 40 publications

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“…The quality of life with conservative versus surgical treatment for macromastia has been investigated in several studies [21,22]. Our results are consistent with those of other studies reporting an improvement in quality of life following surgery [6,8,[23][24][25][26].…”

Section: Discussionsupporting

confidence: 90%

Is Reduction Mammoplasty Cost-Effective? A Cost-Utility Analysis of Surgical Treatment for Macromastia in Germany

Lux¹,

Brendle-Behnisch

Hack

et al. 2021

Breast Care

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Background/Aims: Macromastia can cause physical and psychological problems. Conservative treatments such as physiotherapy and painkillers lead to substantial long-term costs, without any proven medical benefit. In contrast, surgical treatment with reduction mammoplasty leads to improvements in nearly all respects. This study analyzed the costs of reduction mammoplasty and calculated an incremental cost-utility ratio for the treatment. Patients and Methods: The data on 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative) as well as the patients’ files. Topics examined besides demographic data included physician visits, medical imaging, integrative medical procedures, remedial procedures, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before and after surgery. The data were used to calculate costs per year after surgical treatment for symptomatic macromastia. Costs of surgery, including the process of obtaining insurance reimbursement and postoperative complications, were taken into account to calculate the one-time costs of reduction mammoplasty. Results: The patients’ quality of life and satisfaction with the breasts improve after surgery. The one-time costs of reduction mammoplasty per patient amount to EUR 5,885, and the annual costs after surgery are EUR 200. The incremental cost-utility ratio for surgical treatments shows a saving of EUR 380 per quality-adjusted life-year (QALY) gained. Conclusions: These results show that reduction mammoplasty is a treatment that not only improves a patient’s quality of life but also saves money in the longer term in comparison with expensive and ineffective conservative treatment for macromastia.

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Section: Discussionsupporting

confidence: 90%

Is Reduction Mammoplasty Cost-Effective? A Cost-Utility Analysis of Surgical Treatment for Macromastia in Germany

Lux¹,

Brendle-Behnisch

Hack

et al. 2021

Breast Care

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“…We analysed data collected for a prospective cohort study that included adult women with symptomatic breast hypertrophy (aged 18 years or older) assessed for bilateral breast reduction at the Flinders Medical Centre, Adelaide, during 1 April 2007 – 28 February 2018 2 . Participating women who underwent surgery completed assessments before surgery and three, six and twelve months after surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Breast hypertrophy affects quality of life and causes physical and psycho‐social problems for women. Breast reduction surgery is highly effective for relieving the pain and functional problems associated with breast hypertrophy and improves health‐related quality of life 1‐3 . However, breast reduction is often regarded as a cosmetic rather than a functional procedure, and health care funders and third party providers restrict access to surgery, despite evidence of its therapeutic benefit.…”

mentioning

confidence: 99%

Cost‒utility analysis of breast reduction surgery for women with symptomatic breast hypertrophy

Crittenden

Ratcliffe

Watson

et al. 2021

Medical Journal of Australia

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Objective To assess the cost‐effectiveness of breast reduction surgery for women with symptomatic breast hypertrophy in Australia. Design Cost‒utility analysis of data from a prospective cohort study. Setting, participants Adult women with symptomatic breast hypertrophy assessed for bilateral breast reduction at the Flinders Medical Centre, a public tertiary hospital in Adelaide, April 2007 – February 2018. The control group included women with breast hypertrophy who had not undergone surgery. Main outcome measures Health care costs (for the surgical admission and other related hospital costs within 12 months of surgery) and SF‐6D utility scores (measure of health‐related quality of life) were used to calculate incremental costs per quality‐adjusted life‐year (QALY) gained over 12 months, extrapolated to a 10‐year time horizon. Results Of 251 women who underwent breast reduction, 209 completed the baseline and at least one post‐operation assessment (83%; intervention group); 124 of 350 invited women waiting for breast reduction surgery completed the baseline and 12‐month assessments (35%; control group). In the intervention group, the mean SF‐6D utility score increased from 0.313 (SD, 0.263) at baseline to 0.626 (SD, 0.277) at 12 months; in the control group, it declined from 0.296 (SD, 0.267) to 0.270 (SD, 0.257). The mean QALY gain was consequently greater for the intervention group (adjusted difference, 1.519; 95% CI, 1.362–1.675). The mean hospital cost per patient was $11 857 (SD, $4322), and the incremental cost‐effectiveness ratio (ICER) for the intervention was $7808 per QALY gained. The probability of breast reduction surgery being cost‐effective was 100% at a willingness‐to‐pay threshold of $50 000 per QALY and 88% at $28 033 per QALY. Conclusions Breast reduction surgery for women with symptomatic breast hypertrophy is cost‐effective and should be available to women through the Australian public healthcare system.

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“…Most of the symptoms described impair health-related quality of life (HRQoL). A breast reduction (reduction mammaplasty) is considered effective at reducing physical and psychosocial symptoms and improving HRQoL [ 12 , 13 ]; however, similar effects are also achieved when a breast reduction is performed for cosmetic reasons and therefore it is difficult to distinguish which patients should be operated in the publicly funded healthcare system [ 14 , 15 ]. Moreover, there is no standardisation regarding the assessment and prioritising of functional problems, such as back pain, compared to non-functional problems, for example suffering due to appearance [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research

et al. 2021

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Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.

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Does breast reduction surgery improve health-related quality of life? A prospective cohort study in Australian women

Cited by 19 publications

References 40 publications

Is Reduction Mammoplasty Cost-Effective? A Cost-Utility Analysis of Surgical Treatment for Macromastia in Germany

Is Reduction Mammoplasty Cost-Effective? A Cost-Utility Analysis of Surgical Treatment for Macromastia in Germany

Cost‒utility analysis of breast reduction surgery for women with symptomatic breast hypertrophy

A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research

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