EBM SPECIAL TOPIC Outcomes Article ASPS Clinical Practice Guideline Summary on Reduction Mammaplasty Loree K. Kalliainen, M.D. ASPS Health Policy Committee Arlington Heights, Ill. Summary: In May of 2011, the Executive Committee of the American Society of Plastic Surgeons approved an evidence-based guideline on reduction mam- maplasty developed by the American Society of Plastic Surgeons Health Policy Committee. The guideline addresses six clinical questions: procedural efficacy as noted by relief of symptoms, resection weight, the impact of body mass index on surgical complications, use of prophylactic antibiotics, use of drains, and effect on quality of life. The evidence indicates that resection volume is not correlated directly to the degree of postoperative symptom relief. Increased breast resection weight may increase the risks of complication. The evidence is inconclusive on whether increased body mass index is associated with increased risk of complications. Perioperative antibiotics may reduce the risk of infection associated with reduction mammaplasty, and in standard reduction mamma- plasty procedures without liposuction, the use of drains is not beneficial. Re- duction mammaplasty has been shown to improve quality of life. (Plast. Re- constr. Surg. 130: 785, 2012.) S ymptomatic breast hypertrophy in women can have negative physical and psychosocial effects. As a consequence, symptomatic breast hypertrophy is recognized as a medical con- dition for which therapeutic intervention should be considered. Given the lack of a lasting and effective nonoperative treatment for this condi- tion, symptomatic breast hypertrophy is most of- ten managed by reduction mammaplasty. Symptomatic breast hypertrophy is defined as a syndrome of persistent neck and shoulder pain with a tendency toward dorsal kyphosis; painful shoulder grooving from brassiere straps; chronic intertriginous rash of the inframammary fold; ex- acerbation of acne or hidradenitis suppurativa; and/or episodes of headache, backache, and up- per extremity peripheral neuropathies caused by an increase in the volume and weight of breast tissue beyond normal proportions. 1–4 Some pa- tients report difficulty with lifting or with partic- ipating in exercise and other physical activities. Sleeping may be difficult because of the weight of the breasts. Patients may also report low self-es- teem, sexual harassment, and dissatisfaction with body image. 5–7 Although usually seen as symmetric involvement of both breasts, unilateral hypertro- phy occasionally occurs. Breast hypertrophy may also become symptomatic after mastectomy of the opposite breast. Given these consequences, fe- male symptomatic breast hypertrophy is recog- nized as a medical condition that can be effectively addressed surgically. From the American Society of Plastic Surgeons. Received for publication November 9, 2011; accepted April 23, 2012. A complete list of the authors of this article is as follows: Loree K. Kalliainen, M.D., Chair; Dale C. Vidal, M.D., Past Chair; Peter Aldea, M.D.; Steven Bonawitz, M.D.; Kevin Chung, M.D.; Gary Culbertson, M.D.; Lynn Damitz, M.D.; Leland Deane, M.D.; Richard Greco, M.D.; Christopher Hussussian, M.D.; Sami Khan, M.D.; Bill Kortesis, M.D.; Gordon Lee, M.D.; Stephen Metzinger, M.D.; Galen Perdi- kis, M.D.; Adam Ravin, M.D.; Neal Reisman, M.D.; Karie Rosolowski, M.P.H.; Loren Schechter, M.D.; DeLaine Schmitz, R.N., M.S.H.L.; Alexander Spiess, M.D.; Jennifer Swanson, M.Ed.; and William Wooden, M.D. Copyright ©2012 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e318262f0c0 Disclosure: Dale C. Vidal, M.D., Past Chair, has a consultant relationship with Mentor Corporation/ Ethicon/Johnson and Johnson. Leland Deane, M.D., has a consultant relationship with Covidien. Richard Greco, M.D., has a speaker relationship with Mentor Corporation/Ethicon/Johnson and Johnson and a shareholder relationship with Obagi Medical Products. Gordon Lee, M.D., has a consul- tant relationship with Covidien, Inc., LifeCell Cor- poration/KCI, and TEI, Inc. Loree Kalliainen, M.D., Chair, and the other authors have no finan- cial interest to disclose. www.PRSJournal.com 785 rich3/zpr-prs/zpr-prs/zpr01012/zpr5967-12a angnes S4 8/13/12 4:04 Art: PRS204715 Input-nlm Foot AQ: 1 AQ: 1