[A body mass index related scale for reconstructive breast reduction]

Breast reduction is a highly emotional theme and bears conflicting interest groups: 1) women who are suffering from symptomatic macromastia and therefore would wish to have their breast reduction paid by the insurers, irrespective of the amount of resection weight, 2) the insurance companies, who are ready to cover only really medically indicated operations and due to a lack of objective parameters often apply the very strict, arbitrary criterium for a minimum resection weight of 500 g per breast and 3) the surgeons who try to provide a fair, scientific basis for the differentiation between cosmetic and reconstructive indications for breast reductions for the sake of both the patients and the insurance parties. Concerned about such a generalizing rule we undertook a retrospective review of our patients' charts with both, cosmetic and reconstructive indications to judge the available, more-level minimum resection weight standards and see wether they were appropriate to use, or to provide an objective and measurable guideline for a scaled amount of breast reduction beyond the 500 g-resection-rule, adapted to the individual woman's body proportions.

136 women could be included in the study. The resection weight was recorded and correlated to various parameters of the body proportions such as weight, height, the body mass index (BMI) and the body surface. The results were compared to the available minimum resection weight rules.

The resection weight ranged from 55 to 1530 g (mean 450 g +/- 266 g, median 406 g). Overweight was present in 36% of all patients, whereas obesity was present in 7.5% of women. The mean BMI was 25.1 kg/m2. Of the twenty-four patients (18%), who were classified a priori as having a cosmetic indication, 4 (18%) had more than 500 g breast tissue resected bilaterally. On the other hand, in 55% of reconstructive patients less than the predicted 500 g of breast tissue had been resected. From all examined parameters the BMI had the highest correlation to the resected mean breast tissue (r = 0.64, p = < 0.001).

Our retrospective review thus showed that with an arbitrary 500 g breast resection-rule all women beyond the mean values for weight and height were clearly put at a disadvantage. Also not completely solving this problem are the already available, more objective guidelines for graded minimum resection weight recommendations, which have relied on the body weight or the body surface area, parameters that both had a much lower correlation to the resected breast tissue in the patient group than the BMI. We therefore suggest using the BMI as the basis for a graded, more-level weight resection standard for reconstructive breast reductions. This algorithm is related solely to objectifying data and thus avoids biases from empirically derived data or hardly quantifiable breast (or obesity)-related pain syndromes, and respects all the different body builds of women.