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Scant evidence for surgeon’s claims about alternate breast reduction technique

Technique improves breast reduction outcomes

Our Review Summary

This news release from Louisiana State Health Sciences Center summarizes results from a retrospective study of two different surgical procedures used in cosmetic breast reduction. The release claims that a modified version of reduction surgery results in fewer cases of breast pseudoptosis, also called “bottoming out” or sagging breasts.

The release adequately notes that the research was a retrospective review (as opposed to a randomized clinical trial) examining the anatomic differences seen in the use of two recognized surgical approaches — and that 92 percent of surgeries performed on 400 breasts (208 patients) used the Wise pattern incision, which purportedly interferes with the lower suspensory ligaments, and just 7.5 percent used a Boston modification of Robertson technique, which preserves the lower suspensory ligaments. No explanation was given for the wide disparity in procedures analyzed.

And it leaves out some other important information from the research. Although the release claims the Boston modification technique is superior to the Wise incision, the published analysis didn’t demonstrate the superiority of the Boston modification procedure. The release didn’t say why the operating surgeon chose one approach over the other. This is important because it may have been based on preference, skill or patient anatomy.

 

Why This Matters

Reduction mammaplasty is a relatively common plastic surgery procedure with a goal of an aesthetic result. In 2015, there were 68,106 aesthetic breast reduction surgeries in the United States, with men accounting for more than 40 percent of those procedures, according to the American Society of Plastic Surgeons.

Differences in the surgical approach and surgical outcomes result are an important consideration for women and men who seek the procedure. The debate over the best approach has been ongoing for years and while this research adds to the suggestion that the Boston modified Robertson approach may provide superior results with regard to breast sagging, it is not definitive.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The release doesn’t mention cost. According to the American Society of Plastic Surgeons, the average cost of breast reduction (for aesthetic patients only) is $5,631.

Some insurance carriers don’t cover cosmetic breast reduction surgery. In that case, patients must pay for the procedure out-of-pocket. The direct cost of either of the two procedures described could be increased if the results are undesirable.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release addresses benefits of the technique in question in only abstract terms. It notes that in terms of rate of stretch, “for every 1 cm in upper sensory ligament stretch, the lower sensory ligament length increases by 0.45 cm.” That’s neither clear nor useful for people considering the procedure.

The rate of breast sagging was not noted nor was the degree of satisfaction either on the part of the surgeon or the patient. The lead author’s statement that “These results help us provide the best breast reduction outcomes to our patients,” appear rather speculative.

The release also doesn’t say what a good outcome would look like and how long it should remain acceptable until gravity wins out.

While the title of the release suggests improved results with the Boston modification of the Robertson technique, the research merely confirmed the hypothesis that the technique provided “…an anatomical foundation for why our technique may yield better, longer-lasting results.”

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The release does not address the incidence of harms with either method.

Based on our review of the literature on the topic, there are potential complications seen with both techniques including painful scars, wound dehiscence (a surgical complication in which a wound ruptures along a surgical incision), infection requiring antibiotics, and corrective surgery if the original surgery is unsuccessful.

The published study does note a variety of side effects and how often they occurred and also states there was no statistical difference between the rate of harms. This would have been good to mention in the release.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The release presents the broad overview of the research — the type of study, number of patients involved and the type and frequency of the procedure used in the analysis.  The vast majority — 92 percent — of procedures used the Wise procedure. This provides a very lopsided picture of the outcomes.

While the release may correctly state that the study gives additional support for the idea that the modified Robertson technique may be superior to the Wise method, it doesn’t demonstrate this definitively. The quality of the evidence is not satisfactory in terms of backing up the claims that the procedure is superior. A prospective clinical trial would be needed to prove this.

Does the news release commit disease-mongering?

Satisfactory

No disease mongering here. The release also includes some context about how often sagging of breast tissue occurs following breast reduction surgery.

Rather than saying aesthetic breast reduction is a “common” procedure, we’d like to see a more specific number here. As noted in the Why it Matters section, about 68,000 procedures are done annually, with men electing for the surgery nearly as often as women.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

The release doesn’t mention a funding source but that’s understandable since the published study clearly states there is no conflict of interest and no funding source.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The research compared specific anatomic differences seen with two recognized surgical approaches to reduction mammaplasty.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The release mentions standard therapy and a modified technique but doesn’t tell us how widely available the modified technique is, whether it is new or how many plastic surgeons are skilled in the procedure.

Does the news release establish the true novelty of the approach?

Satisfactory

The release doesn’t claim that the research is the first but it does state its “one of the largest breast anthropometry (measurement) studies ever performed.” We agree the study appears to be one of the largest reviews and does add to the literature on the subject.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The release doesn’t rely on sensational language. However, the headline “Technique improves breast reduction outcomes,” and the comments of Dr. Lau, (“..we offer an improved technique that preserves more of the critical breast anatomy. This study provides an anatomical foundation for why our technique may yield better, longer-lasting results” and “These results help us provide the best breast reduction outcomes to our patients”) seem to provide an overly optimistic interpretation of the study results.

Total Score: 5 of 10 Satisfactory

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