A Matched Comparison of the Benefits of Breast Reduction on Health-Related Quality of Life

Omar Elfanagely, M.D.; Sammy Othman, B.A.; Arturo J. Rios-Diaz, M.D.; Jessica R. Cunning, M.B.A.; Cutler Whitely, B.S.; Paris Butler, M.D., M.P.H.; John P. Fischer, M.D., M.P.H.


Plast Reconstr Surg. 2021;148(4):729-735. 

In This Article

Abstract and Introduction


Background: Breast reduction surgery has consistently fallen within the top 10 surgical procedures performed by plastic surgeons. This is because of its capability to relieve the physical and psychological impact of macromastia. Although numerous women pursue consultation, many never undergo the procedure. The authors aim to quantify the impact of breast reduction surgery on quality of life by comparing patients who underwent breast reduction surgery with those who did not.

Methods: Patients seeking breast reduction surgery between 2016 and 2019 were identified. As standard-of-care, patients are surveyed during the consultation visit and postoperative visits using the BREAST-Q. The preoperative survey was readministered a second time for those who did not undergo breast reduction surgery. Propensity score matching, based on patient demographics, comorbidities, and breast examination, was used to balance baseline characteristics.

Results: A total of 100 propensity-matched patients were identified (operative, n = 78; nonoperative, n = 22). Mean participant age was 39.5 ± 25 years and mean body mass index was 31.1 ± 7.4 kg/m2. Quality of life significantly improved in each domain for those in the operative group (p < 0.05). Those who did not undergo breast reduction surgery realized no improvement in quality of life and had a downward trend in quality of life across two of the four domains.

Conclusions: Breast reduction surgery offers a significant improvement in quality of life for macromastia. This matched study demonstrates that patients who are able to undergo breast reduction surgery have a statistically significant improvement in all aspects of quality of life, whereas nonsurgical patients experience no benefit with time, with a trend toward deterioration in specific domains.


The demand for reduction mammaplasty in the United States has remained persistent. For over two decades, since the earliest national data banks, it has fallen within the top 10 most common surgical procedures.[1] The prevalence of macromastia and the desire to seek symptomatic relief[2,3] have not wavered, but the willingness on the part of insurance companies to cover these procedures has. Macromastia not only results in functional disability caused by physical and psychological distress, but also represents a significant morbidity associated with decreased health-related quality of life.[3–5] Consequently, patients denied by insurance and unable to cover the procedure out of pocket are unable to pursue surgical treatment and the associated quality-of-life benefits.

The proven efficacy of reduction mammaplasty on the physical and psychological burden of macromastia has been well documented in the literature.[4–14] Prior studies demonstrate lower than average health-related quality of life in women presenting for reduction mammaplasty for whom surgery results in a significant, quantifiable improvement.[15,16] However, these studies fail to capture quality-of-life data on patients who do not undergo reduction mammaplasty. As such, there is a need to quantify these patients' experiences, particularly in the context of demonstrating broader benefits irrespective of insurance-mandated standards. In this study, we set to answer the following questions: Is the baseline quality of life significantly different between women who undergo and do not undergo reduction mammaplasty? Is there a prospective change in quality of life in women interested in reduction mammaplasty that do not undergo surgery? We hypothesize that women who do not undergo reduction mammaplasty will have deterioration in quality of life on the BREAST-Q instrument relative to those women who undergo surgery.