FREQUENCY AND FACTORS ASSOCIATED WITH MEETING BMI REQUIREMENTS FOR BREAST REDUCTION

Objectives: Macromastia can be a distressing condition to have and many women will seek breast reduction consultation for alleviation of their symptoms. However, due to its association with obesity, many women with elevated BMIs are considered too high risk and are refused surgery. Our study sought to explore what proportion of women are turned away during the initial consultation for an elevated BMI (>35), what factors were associated with women who successfully lost the weight, and what a plastic surgeon can do during that initial consultation to aid them in that goal.

Methods: Our study consisted of a retrospective chart review of women who received an initial consultation for bilateral breast reduction surgery and were not offered surgery due to an elevated BMI. The consultation was with any of our four plastic surgeons in year 2019, before the altering effects of COVID-19. Initial consultation notes were evaluated for weight loss recommendations by the plastic surgeon, including referral to PCP, nutrition, psychiatry, or bariatric surgery programs. Those patients were then followed to see if they lost the weight, how they did, and if they successfully underwent breast reduction surgery.

Results: A total of 100 women visited our plastic surgeons for a bilateral breast reduction consultation in the year 2019. Of those, 52% of patients were not offered surgery due to their elevated BMI. The most common weight loss recommendation by our plastic surgeons was a referral to bariatric surgery. No recommendation given by a plastic surgeon was significant associated with eventual surgery. Women who successfully lost weight and underwent breast reduction surgery were more likely to see report diet, exercise, and visiting their PCP.

Conclusion: Macromastia can be a distressing condition to have and many women will seek surgical consultation. However, due to its association with obesity, many of these women will be considered too high risk due to their BMI. Currently, the majority of women initially turned away are unable to lose weight and continue to live with symptoms of macromastia. Our findings highlight a large missed opportunity for plastic surgeons to provide effective counseling and guidance to patients for successful weight loss.To increase the number of successful breast reductions and improve the life of many additional women, it is in the plastic surgeons’ best interest to identify more effective strategies for counseling patients regarding weight loss.