gms | German Medical Science

Introduction: Breast reductions and mastopexies continue to rank among the most frequently performed plastic surgical procedures worldwide. However, there exists consensus on several aspects of the procedure, but a plethora of controversies remains. Aim of this study was to compare the most relevant operative factors on an international level in order to further standardize this common procedure according to evidence-based guidelines.

Methods: A questionnaire was sent to over five thousand active breast surgeons in 77 countries worldwide. The survey was divided in categories according to the volume of removed breast tissue: 50–500 g, 500–1000 g, and >1000 g and inquired about current controversies, new technologies, common practices, secondary procedures, and surgeon demographics. The findings and variations were evaluated and correlated to evidence-based literature.

Results: A total of 1431 surveys were gathered, corresponding to a response rate of 29 percent. While certain approaches and common practices prevail also on an international basis, there exist several geographic controversies. For example, while the majority of respondents (51–79 percent) reported to use the inverted T approach, discrepancies were seen in the use of pedicle type. Irrespective of resection weight, in most geographic regions a superior or supero-medial pedicle made the first rank, except in North America and South East Asia, where an inferior based vascularization seems to be preferred.

Conclusion: There exists accordance regarding several aspects of breast reduction surgery, however international practice patterns remain very incoherent. Plastic surgeons may still benefit from internationally applicable high-level studies in order to create universally applicable, standardized, and evidence-based practice guidelines.