Evidence-based medicine: Reduction mammaplasty

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Accurately state the indications for breast imaging prior to breast reduction; 2. List the modifiable risk factors in a woman considering breast reduction. 3. Use perioperative antibiotics in an evidence based fashion. 4. Identify factors that are associated with higher rates of perioperative complications. 5. Describe the risks and benefits of breast infiltration with epinephrine. 6. Describe the pros and cons of using drains following breast reduction. 7. Describe the incidence of invasive breast cancer in surgical specimens compared to autopsy specimens. 8. Identify common questionnaires that can be used to track short and long-term outcomes following breast reduction. 9. List at least three current practices that are now evolving and changing based on evidence based medicine. SUMMARY: This paper is designed to summarize key evidence based steps in the care of women undergoing reduction mammaplasty. In addition, the authors identify gaps between how plastic surgeons practice breast reduction and what the best evidence supports. The article was prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification Program of the American Board of Plastic Surgery.