Reduction Mammoplasty: Intraoperative Weight Versus Pathology Weight and Its Implications

Background: Despite the efficacy of reduction mammoplasty and demonstration that resection weight does not predict symptomatic relief of macromastia, many insurers still rely on the Schnur scale or predetermined resection weight for reimbursement. Insurers review pathology reports to determine reimbursement. Tissue desiccation and handling decrease specimen weight prior to pathology evaluation. Surgeons often make judgments based on intraoperative weight. Our goal was to determine whether (1) discrepancies exist between intraoperative and pathology weights, and (2) how differences may impact reimbursement and medical practice. Methods: Medical records review was performed on 25 reduction mammoplasty cases performed between 2007 and 2010, yielding 48 specimens. Tumescent was never used. Weight of each specimen from operative and pathology reports was reviewed and compared. The 2-sample Kolmogorov-Smirnov test was used to compare sample weights. Results: Comparison of intraoperative versus pathology specimen weights revealed an average 7% weight decrease (range, +11% to -45%). Average and median specimen weight decrease from intraoperative to pathology weights was 48 g (SD = 71 g) and 31 g (interquartile range = 6.6-58 g), respectively. Average intraoperative specimen weight was 780.7 g (SD = 375.3 g; range, 290-2238 g). Average pathology specimen weight was 732.3 g (SD = 358.4 g; range, 265-2053.6 g) (P < .001) All but 2 samples weighed less in pathology. Conclusion: Desiccation and handling between intraoperative and pathology weighing decrease specimen weight. Weight discrepancies may have implications on coverage and reimbursement by insurers. Awareness of such discrepancies can help plastic surgeons and patients avoid unexpected coverage and reimbursement complications.