A Retrospective Follow-up Study After Reduction Mammaplasty With The Modified Round Block Technique

Background There are many surgical procedures for reduction mammaplasty nowadays, but each presents particular disadvantages. From 2000, a design which was modified from the original technique of Benelli, has been used in 68 breasts of 34 patients by us and got satisfactory results. But there were no follow-up and evaluation of this technique.Objective The purpose of this study is to (1)summarize the evaluation system of this technique, which would offer reference for the similar study. (2)compare changes in physical and psychosocial symptoms,health-related quality of life,breast appearance,sensory function of the breast,the scars and complications in women with symptomatic macromastia before and after breast reduction with the modified round block technique, (3)fmd the possible factors which may impact the relief of the symptoms,the improvement of the quality of life and breast appearance,sensory function of the breast,the scars and complications.Methods (1) The special table was worked out to collect the information of these patients. We set the tables for collect the normal information of the patients, the surgery information, the symptom information, the information about the quality of life, the breast appearance information, the scar information, the sensation information and the complitation information; (2) According to the different degrees of the symptoms before and after the surgery, the scores were graded from 0 to 3 (0—no symptom, 3—can not bear the symptom) .(3)To evaluate the quality of life, we used a general questionnaires: the Short Form-36 Health Survey Questionnaire (SF-36) which has good reliability and validity. (4) we used the measured datas,the VAS questionnaire and the evaluation scale for breast to evaluate breast appearance respectively. Reduced breasts were also compared with cosmetically optimal breasts to compare for measured levels using our defined measurements. (5)Vancouver Scar Scale and the VAS questionnaire were used to evaluate the scars after the reduction. (6) According to the different degrees of the sensory function after the surgery, the scores were graded from 0 to 3 (0—no sensory, 3—the same as before the surgery). (7)The incidence rate of complications was collected to compare between the obesity and the normal. The scores of the patients before and after the surgery were collected respectively. (8) Statistical analysis for comparison was carried out with SAS 9.1.3. Found the correlations between the remission rate of the symptoms,improvement rate of the quality of life and the breast appearance,the scars,the sensory function,the incidence rate of complications and the possible factors. (9)Get a summary of all these patients and give some guidance for our clinic.Results (1)In all the patients enrolled, preoperatively breast pain and skin irritation was present in 28% respectively, poor posture was in 39%, upper back pain was in 44%, neck pain and shoulder pain was in 50% respectively, embarrassed patients was more than 89%, painful brasserie strap grooving was more than 89%. In more than 89 % patients found it was troublesome to find suitable clothes and were unsatisfactory with their breasts. And all these complaints were significant before the operation. Significant difference occurred between preoperative and postoperative symptom in all the aspect except "breast pain" and "skin irritation". And symptom relief and improved body image occurred independently of preoperative age,the tissue removed,the body mass index and the times followed-up. Increased self-esteem after surgery, increased personal and public self-consciousness were observed. (2) SF-36 showed significant higher quality of life after the operation with regard to 7 of 8 investigated domains except "Genental Health". "Role of Emotion" increased most significantly. We did not found any strong correlation between the improvement rate of the quality of life and any other factors. (3) The breast appearance after the reduction was aesthetic and persistent. Reduced breasts were also close to cosmetically optimal breasts using our defined measurements except "the distance between the two nipples". And the distance between the nipple and the suprasternal notch .improved most significantltly. We found positive correlation between the improvement rate of the evaluation scale for breast and age, but we did not found any other correlation. (4)The scars were not evident in the malority of the patients. Three of the patients chose to undergo additional surgery for hyperplastic scar. We did not found any correlation between the scars,the sensory function and any other factors.There is no difference of the the incidence rate of complications between the obesity and the normal.Conclusion The data of this study provide further evidence that (1) the physical and psychosocial symptoms of women who had been operated for breast hypertrophy with the modified round block technique had a significant relief. (2) The quality of life had a significant improvement. (3) The breast appearance also had a significant improvement. And the older the patients are, the more significant the improvement rate of the evaluation scale for breast is. The times followed-up,the tissue removed and the body mass index had no impact to it. (4) The scar was not evident at all. (5) The complications were few and not serious. There was no significant deviation between the obesity and the normal. Patients had a higher degree of satisfaction overall. These data are further evidence that breast hypertrophy is not solely an esthetic problem. The breast reduction with the modified round block technique was an ideal technique.