Rising costs despite declining resource utilization: Widening disparities in adolescent reduction mammaplasty

The volume of adolescent reduction mammaplasty has increased substantially over the past decade. However, access is often constrained by inconsistent insurance policies. We examined longitudinal trends in costs, resource utilization, and surgical timing in this population.

A retrospective cohort study was conducted using data from the Pediatric Health Information System database from 2007 to 2025. Female patients aged 10 to 21 years who underwent reduction mammaplasty were included. Primary outcomes included inflation-adjusted total hospital costs (RCC-based) and standardized resource utilization. Multivariable models and interaction analyzes identified predictors of cost and surgical timing.

Among 6164 patients, standardized resource utilization decreased by 0.3% annually (p < 0.001), whereas hospital costs rose by 0.3% annually (p = 0.003). This cost inflation was concentrated among publicly insured (p < 0.001) and uninsured (p = 0.018) cases, whereas costs for private insurance remained stable (p = 0.741). Black patients (p < 0.001) and those with complex chronic conditions (p < 0.001) incurred significantly higher costs. Public insurance (OR 1.46, p = 0.029) and Hispanic ethnicity (OR 1.67, p = 0.048) were independent predictors of a non-zero diagnosis-to-surgery interval. The probability of this interval increased more sharply over time for publicly insured versus privately insured patients over the study period.

The economic burden of adolescent reduction mammaplasty has increased significantly despite a longitudinal decline in resource utilization. Cost inflation was disproportionately concentrated among publicly insured and minority patients. Policy efforts should address administrative barriers and widening disparities to ensure equitable access to care.