A body mass index related scale for reconstructive breast reduction

Breast reduction is a highly emotional topic, involving three conflicting interests: (a) women suffering from symptomatic macromastia, (b) health insurance companies, and (c) surgeons. Many insurance companies, including those in Austria, cover (if at all) only breast reductions with a minimum resection weight of 500 g per breast, irrespective of the physical build of the woman involved. We retrospectively reviewed 136 patients' charts from both cosmetic and reconstructive breast reduction operations and compared the breast resection weight to various parameters of body proportions such as height, weight, body mass index (BMI), and body surface area to determine the parameter best correlated to the weight of breast tissue resected. From this we developed a graded scale for guiding future operations irrespective of a woman's body build. The resection weight ranged from 55 to 1530 g (mean 450±266, median 406); mean BMI was 25.1. The arbitrary 500 g breast resection rule discriminates against women of nonaverage weight or height: of 24 patients (18%) with a cosmetic indication 4 had more than 500 g breast tissue resected bilaterally, while in 62 reconstructive patients (46%) less than the arbitrary 500 g breast tissue was resected. The parameter best correlated to the mean weight of breast tissue resected (sum of both breasts) was BMI. We therefore suggest using the BMI as the basis for a graded weight resection guideline for reconstructive breast reductions. The BMI-based scale treats equally women of all types of body build. In women with a BMI greater than 30 (classified as adiposity) we recommend that breast reduction be postponed, and a general body weight reduction program be undertaken for the sake of a higher impact on general well-being.