Reduction Mammaplasty

Publication Date: February 28, 2022
Last Updated: August 2, 2022

Summary of Recommendations

The work group recommends that postmenarche female patients presenting with breast hypertrophy should be offered reduction mammaplasty surgery as first-line therapy over nonoperative therapy based solely on the presence of multiple symptoms rather than resection weight. (S, Strong)
1986175
The work group recommends that clinicians counsel postmenarche patients with symptomatic breast hypertrophy considering reduction mammaplasty that they may have a higher risk of complications if they are older than 50 yr, have a body mass index greater than 35 kg/m2, or require chronic corticosteroid use (all independent variables). (M, Moderate)
1986175
The work group recommends that postmenarche female patients presenting with symptomatic breast hypertrophy identified as nicotine users be referred to nicotine/tobacco cessation programs and encouraged to stop smoking before surgery. (M, Moderate)
1986175
The work group finds that it is acceptable for plastic surgeons to perform either superomedial pedicle or inferior pedicle techniques for reduction mammaplasty for postmenarche female patients presenting with symptomatic breast hypertrophy (other less common techniques were not reviewed). (S, Option)
1986175
The work group suggests that plastic surgeons infiltrate epinephrine-containing solutions at the surgical site for postmenarche female patients undergoing reduction mammaplasty. (M, Moderate)
1986175
The work group recommends that plastic surgeons should administer local anesthetic for postmenarche female patients undergoing reduction mammaplasty. (S, Strong)
1986175
The work group recommends that plastic surgeons incorporate nonnarcotic strategies for reducing postoperative pain in female patients undergoing reduction mammaplasty. (L, Moderate)
1986175
The work group recommends that plastic surgeons not routinely use intraoperative drains for female patients undergoing reduction mammaplasty. (M, Moderate)
1986175
The work group recommends that plastic surgeons send breast tissue removed from postmenarche female patients undergoing reduction mammaplasty for pathologic evaluation. (M, Moderate)
1986175
The work group suggests that when the Surgical Care Infection Program protocol is followed, clinicians not routinely prescribe postoperative oral antibiotics for female patients undergoing reduction mammaplasty surgery. (L, Weak)
1986175

Recommendation Grading

Overview

Title

Reduction Mammaplasty

Authoring Organization

American Society of Plastic Surgeons

Publication Month/Year

February 28, 2022

Last Updated Month/Year

April 1, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D016462 - Mammaplasty

Keywords

Mammaplasty, Breast reduction, Reduction mammaplasty

Source Citation

Perdikis G, Dillingham C, Boukovalas S, Ogunleye AA, Casambre F, Dal Cin A, Davidson C, Davies CC, Donnelly KC, Fischer JP, Johnson DJ, Labow BI, Maasarani S, Mullen K, Reiland J, Rohde C, Slezak S, Taylor A, Visvabharathy V, Yoon-Schwartz D. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg. 2022 Mar 1;149(3):392e-409e. doi: 10.1097/PRS.0000000000008860. PMID: 35006204.

Supplemental Methodology Resources

Data Supplement