Smaller breast reduction surgeries provide health benefits and should be reimbursed

Smaller-framed women reap significant health and quality-of-life benefits from breast reductions that involve the removal of under 500 grams of tissue per breast, according to a first-of-its-kind study from NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the New York University School of Medicine.

The finding runs counter to the policies of most U.S. health insurance companies, who typically do not reimburse women for these smaller mammoplasties because insurance companies deem them to be only of cosmetic value.

"Of course, as plastic surgeons, we know that isn't true -- you can't apply the same number, in terms of the benefits of excised breast tissue, to different-sized women," says co-author Dr. Jason Spector, a plastic surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and assistant professor of surgery (plastic surgery) at Weill Cornell Medical College.

"Smaller women are going to have proportionally smaller breasts, but for their particular frame, their breasts may still be far too large and uncomfortable," Dr. Spector explains.

The study, appearing in the Sept. 15 issue of Plastic and Reconstructive Surgery (already available online), found that breast reductions of less than 500 grams per breast greatly eased women's back, neck and shoulder pain. The procedures also improved their quality of life by allowing them to exercise more, play sports and choose from a wider variety of clothing.

All of the 59 patients in the study had come to the study's co-author, plastic surgeon Dr. Nolan S. Karp of NYU Medical Center, complaining of pain linked to uncomfortably large breasts. Dr. Karp is associate professor of plastic surgery at the NYU School of Medicine.

None of the women in the study had ever undergone any form of breast augmentation before.

On average, the mammoplasties involved the surgical removal of 415 grams of breast tissue per breast (830 grams total), for an average breast reduction of just over 2 cup sizes. Seventeen of the women had less than 750 grams total of breast tissue removed -- an average decrease of 1.7 cup sizes.

Three months and then one year after their surgery, the women were asked about changes in pain and quality of life. They were asked to rate their pain from a score of 1 to 5 (5 being highest).

Scores fell dramatically after the reduction mammoplasties -- in categories including lower-back pain, neck pain, headache and bra-strap "grooving."

"Women were also greatly relieved that they were more able to engage in healthful activities such as running or playing sports -- demonstrating that breast reduction surgeries have even wider health implications," Dr. Spector says.

None of these findings came as a great surprise to this experienced plastic surgeon.

"However, studies like this are needed if we are ever going to reverse the arbitrary ceiling the insurance industry has in place in terms of reimbursing breast reduction surgeries," Dr. Spector explains.

"The smaller-framed woman who comes to us complaining of chronic breast-linked pain is not having this procedure done for a 'lift' or any cosmetic purpose," he says. "Breast reduction surgeries involve some scarring, general anesthesia, and the usual level of surgical risk. Patients are not taking them lightly."

Dr. Spector is optimistic that reimbursement policies may change, based on the new findings.

"This is going to be useful data that patients and other plastic surgeons should be able to turn to as they go back and forth with insurance companies trying to get the procedure approved," Dr. Spector says. "Women come in all shapes and sizes, and we're just pointing out that breast reduction -- like many other surgeries -- is definitely not a one-size-fits-all proposal."