The effect of new inclusion criteria on patient selection for reduction mammaplasty

Purpose - To evaluate the impact of rationing guidelines on the practice of reduction mammaplasty, with particular reference to patient selection.Design methodology approach - A retrospective audit was performed. Patients who were accepted for surgery in the first nine months following the date of publication of new and explicit inclusion criteria were compared with patients who were accepted for surgery in the 15 months preceding publication.Findings - Of 131 consecutive patients, 98 were accepted before publication of the inclusion criteria, with 33 after. A total of the 97 of 98 and 33 of 33 were symptomatic. Conformity to criteria for body mass index (BMI) increased from 65 of 98 (66 per cent) to 25 of 33 (76 per cent, p=0.143) Attendance at pre-operative breast seminar increased from 72 of 98 (73 per cent) to 29 of 33 (88 per cent, p=0.099). Incidence of smoking increased from 18 of 98 (18 per cent) to 7 of 33 (21 per cent, p=0.799). Patients under the age of 30 accounted for this increase. The number of cases who failed on more than one criterion fell from 17 of 98 (7 per cent) to 2 of 33 (3 per cent, p=0.155).Practical implications - Demonstrates a non-significant reduction in the number of obese patients being accepted for surgery, and a non-significant increase in uptake of pre-operative nurse led seminars in the practice. Since publication of the inclusion criteria, all but one of the patients accepted for surgery with exclusion criteria failed on the basis one criterion only. Not successful in enforcing abstinence from smoking as a condition for surgery, particularly among younger patients. To help do this objective ways to assess smoking status need to be looked at. A re-audit is required to complete the loop.Originality value - This is the first paper to present audit results for the new inclusion criteria for reduction mammaplasty.