Background: There is great demand for breast reduction surgery for macromastia. This demand exceeds both the capacity to see new patients and operative capacity. In 2012 a new approach of patient selection was adopted by our Plastic Surgery department to manage this problem.
Method: Patients referred for breast reductions, had medical photos taken and completed an impact on life (IOL) questionnaire. Photos were scored by consensus of a consultant panel. Patients above a designated threshold score received a first specialist assessment (FSA) appointment. We retrospectively examined all patients considered for breast reduction from 2012 to 2015.
Results: 96 Patients were considered by the panel. 51 patients progressed to operation, 37 of those patients had a complete data set. The average breast weight removed was 1379.24g (Standard deviation 581.69g). When panel scores were considered without an IOL score, 7 patients who proceeded for operation would have been declined. These 7 patients had a mean breast weight removed of 875.00g. This was significantly less than the mean of the other 31 patients (p<0.01). There was no significant correlation between the breast weight removed and the IOL score (p=0.55) or panel score (p=0.07).
Discussion: Prior to 2012 patients were triaged based on breast dimensions. Panel assessment of clinical photographs combined with an IOL questionnaire provides a pragmatic solution to triaging patients for breast reduction surgery. The introduction of an IOL score has altered access for 19% of patients.
Conclusion: Adding an IOL score can supplement virtual assessment and provide improved equity of access for patients with macromastia.