Bilateral breast reduction and obesity: What is the ideal resection enabling significant improvement in back pain according to the body mass index?

Introduction. - Dorsal pain is the first symptoms about which patients with macromasty complain. Health insurance reimbursement takes place if the resection weight is at least 300 grams per breast. However, this weight is not correlated with the body mass index (BMI). In this context, we sought to determine the ideal resection weight leading to significant BMI-based improvement. Materials and methods. - This is a multicentre prospective study of patients operated between November 2016 and July 2017. In the year following the surgical procedure, we studied overall improvement using the INDIC questionnaire. Any INDIC improvement of at least 50% was considered positive. These data were then compared to tissue resection weights and BMI. In order to refine our results, age, bra size, comorbidities and complications were also identified. Results. - Forty-one patients were included in our study. Average age was 41.5 +/- 11.4 years. Average BMI was 27.9 +/- 4.1 kg/m(2). The bra cap chosen after the procedure were C. Average resection weight was 663 +/- 352 g per breast. The preoperative and postoperative INDIC scores were 734.9 +/- 226.6 points and 225.3 +/- 319.1 points, respectively (P = 0.001). Significant improvement was achieved at 12 months in 71.8% of patients. A correlation of 38.7 g/kg/m(2) was found between breast resection weight and BMI. Conclusion. - This study clarifies the correlation between the breast resection weight required to relieve optimal back pain and BMI. It defines three categories of patients: patients with standard weights (18 < BMI < 25), overweight (25 < BMI < 30) and obese (BMI > 30). Overweight and obese patients require greater tissue excretion to be relieved optimally. These findings underline a need to adjust the health insurance threshold for these types of patients. (C) 2019 Elsevier Masson SAS. All rights reserved.