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Paulus E, Atlan M, Frasca D, Julienne A, Sauniere D, Leclère FM. [Bilateral breast reduction and obesity: What is the ideal resection enabling significant improvement in back pain according to the body mass index?]. ANN CHIR PLAST ESTH 2019; 65:124-130. [PMID: 31178310 DOI: 10.1016/j.anplas.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
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 300grams 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±11.4years. Average BMI was 27.9±4.1kg/m2. The bra cap chosen after the procedure were C. Average resection weight was 663±352g 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 12months in 71.8% of patients. A correlation of 38.7g/kg/m2 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.
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Affiliation(s)
- E Paulus
- Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - M Atlan
- Service de chirurgie plastique reconstructrice esthétique, microchirurgie et régénération tissulaire, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - D Frasca
- Service d'anesthésie, réanimation, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
| | - A Julienne
- Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
| | - D Sauniere
- Service de chirurgie plastique, reconstructrice et esthétique, université de Montpellier-Nîmes, CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France
| | - F M Leclère
- Service de chirurgie plastique, brûlologie, chirurgie de la main, et chirurgie de la réassignation génitale, université de Poitiers, CHU de Poitiers-La Milétrie, 2, rue de la Milétrie, 86000 Poitiers, France
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Mazouz Dorval S, Salleron J, Guenane Y, Nguyen Van Nuoi V, Ozil C, Revol M, Sorin T. Role of ropivacaine infiltration analgesia in bilateral reduction mammaplasty. ANN CHIR PLAST ESTH 2016; 61:91-4. [PMID: 26908218 DOI: 10.1016/j.anplas.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Bilateral reduction mammaplasty (BRM) is a common procedure in plastic surgery. Our study aims to determine whether single-shot infiltration with ropivacaine during surgery reduces postoperative pain and decreases analgesic consumption. METHODS In a prospective and monocentric study, all women operated by a single senior plastic surgeon, for whom BRM had been performed were included. The same surgical technique was performed for all patients (a superior pedicle, wise-pattern BRM with a closed-suction drainage). During the first half first part of the study period, none of the patients received ropivacaine infiltration (control group) and during the second half, all the patients received this infiltration (ropivacaine group). Infiltration was performed with a 20 mL solution of ropivacaine per side. Analgesic consumption and pain intensity were recorded during hospitalization and following discharge. RESULTS Forty-nine patients were divided into two groups (29 in the ropivacaine group and 20 in the control group). The ropivacaine group had a significantly lower consumption than the control group on all analgesics (paracetamol, tramadol, nefopam and morphin) (P < 0.001). Pain measurement reflected significantly lower scores in the ropivacaine group, both at four hours and three days postoperatively (P < 0.001). This difference was no longer significant at day 7 postoperatively (P=0.147). CONCLUSION Single-shot ropivacaine infiltration during surgery reduces postoperative pain and decreases the analgesic consumption. With this peroperative infiltration, BRM can be performed with good pain control and moderate analgesic consumption, limiting side effects.
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Affiliation(s)
- S Mazouz Dorval
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France
| | - J Salleron
- Biostatistics department, Lorraine Cancer Institute - Alexis Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Y Guenane
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France
| | - V Nguyen Van Nuoi
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France
| | - C Ozil
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France
| | - M Revol
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France
| | - T Sorin
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Paris Diderot University, Sorbonne Paris Cité, 75013 Paris, France.
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