A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research

BMC Surgery

Christian Jepsen¹  Emmelie Widmark-Jensen¹  Emma Hansson¹  Fredrik Wärnberg²  Håkan Hallberg³  Lennart Jivegård⁴  Mikael Svensson⁵  Maud Eriksson⁶  Ann Liljegren⁶  Max Petzold⁷  Susanne Bernhardsson⁸ 

[1] Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden;Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden;Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden;Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Blå Stråket, 413 46, Gothenburg, Sweden;Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden;Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden;Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden;Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Medical Library, Vita Stråket 12, SE-413 45, Gothenburg, Sweden;Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden;School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden;Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, SE-411 19, Gothenburg, Sweden;Health Technology Assessment Centre, Region Västra Götaland, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden;Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;

关键词: Breast reduction;    Reduction mammaplasty;    Breast hypertrophy;    Plastic surgery;    Evidence-based medicine;    Prioritizing;   

DOI  :  10.1186/s12893-021-01336-7

来源: Springer

【 摘 要 】

BackgroundThere is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction.MethodsA systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible.ResultsFifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%.ConclusionThere is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified.Pre-registrationThe study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.

【 授权许可】

CC BY