Redefining the Role of Resection Weight Prediction in Reduction Mammaplasty and Breaking the “One-Scale-Fits-All” Paradigm

Abstract

Background: Reduction mammaplasty is a highly effective procedure for treatment of symptomatic macromastia. Prediction of resection weight is important for the surgeon and the patient, but none of the current prediction models is widely accepted. Insurance carriers are arbitrarily using resection weight to determine medical necessity, despite published literature supporting that resection weight does not correlate with symptomatic relief. What is the most accurate method of predicting resection weight and what is its role in breast reduction surgery? Methods: The authors conducted a retrospective review of patients who underwent reduction mammaplasty at a single institution from 2012 to 2017. A senior biostatistician performed multiple regression analysis to identify predictors of resection weight, and linear regression models were created to compare each of the established prediction scales to actual resected weight. Patient outcomes were evaluated. Results: Three-hundred fourteen patients were included. A new prediction model was created. The Galveston scale performed the best (R 2 = 0.73; p < 0.001), whereas the Schnur scale performed the worst (R 2 = 0.43; p < 0.001). The Appel and Descamps scales had variable performance in different subcategories of body mass index and menopausal status (p < 0.01). Internal validation confirmed the Galveston scale’s best predictive value; 38.6 percent and 28.9 percent of actual breast resection weights were below Schnur prediction and 500-g minimum, respectively, yet 97 percent of patients reported symptomatic improvement or relief. Conclusions: The authors recommend a patient-specific and surgeon-specific approach for prediction of resection weight in breast reduction. The Galveston scale fits the best for older patients with higher body mass indices and breasts requiring large resections. Medical necessity decisions should be based on patient symptoms, physical examination, and the physician’s clinical judgment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Predictive value and accuracy of prenatal four-dimensional color ultrasound for fetal abnormal development

“…The use of the GE-E10 ultrasound and a combination of multiple indicators to assess fetal weight can improve prediction errors due to maternal substandard weight and measurement methods. [16] The GE-E10 ultrasound machine is equipped with obstetrics-specific software that can scan and measure certain fetal meridians and can visualize all physiological indicators of the fetus. A fetal weight prediction model is created without the need for complex calculations and is also able to show the exact weight of the fetus.…”

“Breast Resection Weight Prediction and Insurance Reimbursement in Reduction Mammoplasty: Which Scale is Reliable?”

“…All four scales measure different individual patient characteristics. Both Appel 6 and Descamps 7 formulas collect the sternal notch–to-nipple and nipple-to–inframammary fold values, whereas the Galveston formula 8 also includes the body mass index (Table 1). The average body mass index in the United States has been increasing in recent years; therefore, there is a need for using formulas that are more reliable in the U.S. population.…”

“…4 Postoperatively, the predicted resection weights estimated by the Schnur scale are compared to the actual resection weights from pathology reports to determine whether the patient meets criteria for insurance reimbursement for the reduction mammaplasty. Many formulas have been described to estimate resection weight in reduction mammaplasty, such as the Schnur, 5 Appel, 6 Descamps, 7 and Galveston 8 scales (Table 1). As Dr. Paul Schnur emphasized in his original article, one of his motivations for the creation of the Schnur scale was to prevent women with smaller breasts from being denied insurance coverage, because companies frequently required a minimum resection weight of 500 g. 9 Unfortunately, the Schnur scale resulted in the unintended consequences of coverage denials for patients who did not meet the minimum resection weight suggested by the tool, but who would have otherwise benefited from the procedure to relieve macromastia symptoms.…”

Study on the Application of GE-E10 Ultrasound Equipment to Estimate Fetus Weight and Compare Its Accuracy With Birth Weight

“…Fetal biparietal diameter and femoral length are bone markers, which are rarely affected by other factors when the measurement methods are grasped. The application combining GE-E10 ultrasound and multi-parameter comprehensive estimation of fetal weight will effectively correct the errors caused by maternal obesity, thinness and measurement methods to a large extent [16]. Equipped with corresponding obstetrics software, GE-E10 ultrasound device will directly display the physiological parameters of the fetus after scanning and measuring some meridians of fetus.…”