Evaluation of the Impact of Physical Therapy on Patients with Macromastia Seeking Breast Reduction Surgery

ACC 

Introduction: Macromastia affects women's quality of life through back pain, neck pain, rashes, and discomfort with maneuvering daily living.¹ Conservative treatment includes weight loss, supportive bras, anti-inflammatory medication, and physical therapy (PT); however, these treatments rarely provide lasting relief.¹ Despite strong evidence that patients undergoing breast reduction improve in areas of physical, psychological and sexual wellbeing, insurance companies have continued to deny surgery even after patients have participated in various conservative treatments with no PT.¹'² High quality literature on the efficacy of PT in patients with macromastia is lacking, but a small prior studies did not demonstrate PT to provide full permanent relief of the symptoms.³ The purpose of our study was to expand on the role of conservative treatment in macromastia by assessing the impact of PT versus surgery and characterize patient factors associated with progression from PT to surgery.

Methods: We conducted a retrospective cohort study of patients diagnosed with macromastia who had an appointment with a plastic surgeon at University of Colorado Hospital from 2017 to 2020. Patient charts were reviewed and information was collected on patient-reported symptoms, patient characteristics, conservative treatments, physical therapy duration, and reported effectiveness. Whether patients ultimately progressed to surgical treatment was also collected. All patients were identified prior to chart review to minimize selection bias. Descriptive and bivariate statistical analysis was performed.

Results: A total of 200 patients with macromastia met inclusion criteria. The most common symptom was back pain (N=190, 95.0%). A total of 175 (87.6%) patients had PT. Of those, only 10 (5%) patients reported partial relief, and 95 (47.5%) proceeded with surgery. The mean time from diagnosis to surgery was 640 days, and mean time from plastic surgery consult to surgery was 252 days. Patients with military health care plans waited less time to undergo a breast reduction after their initial consult (145 days) compared to private insurance (255 days, P=0.04) or Medicaid (274 days, P=0.03). Of patients that underwent PT, 92 (52.5%) participated in more than 12 weeks of PT, and only 10 (5.71%) of the patients reported partial relief. PT duration did not show a significant correlation with patients ultimately progressing to surgery (P=0.07).

Conclusion: Patients frequently undergo PT prior to breast reduction surgery despite few experiencing significant relief and most eventually requiring definitive treatment with surgery. Conservative treatment with PT should be further studied and potentially reconsidered as an insurance company requirement prior to breast reduction. Future work by this group will focus on expanding the cohort of patients and gaining patient perspectives through a standardized survey on their symptomatic relief with PT and breast reduction.

References:
1. Rawes CMA, Ngaage LM, Borrelli MR, Puthumana J, Slezak S, Rasko YM. Navigating the Insurance Landscape for Coverage of Reduction Mammaplasty. Plast Reconstr Surg. Nov 2020;146(5):539e-547e. doi:10.1097/prs.0000000000007241
2. Wang AT, Panayi AC, Fischer S, et al. Patient-reported Outcomes After Reduction Mammoplasty Using Breast-Q: A Systematic Review and Meta-analysis. Aesthet Surg J. Nov 22 2022;doi:10.1093/asj/sjac293
3. Collins ED, Kerrigan CL, Kim M, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg. Apr 15 2002;109(5):1556-66. doi:10.1097/00006534-200204150-00011

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