Mental Health Conditions and Health-related Quality of Life Changes after Reduction Mammaplasty in Younger Patients

Background:. Reduction mammaplasty is increasingly common in younger patients with macromastia. Unfortunately, a recent surge in mental health disorders has been documented in this population. It is unknown how mental health disorders affect patients undergoing reduction mammaplasty. This study examines the impact of concurrent mental health conditions on health-related quality of life outcomes after reduction mammaplasty. Methods:. A prospective cohort study was performed on patients aged 12–21 years undergoing reduction mammaplasty. Patients were assigned to unaffected or affected (baseline mental health condition) cohorts based on psychological history. Patients completed the Short-form-36, Rosenberg Self-esteem Scale, Eating Attitudes Test 26, and Breast-related Symptoms Questionnaire at baseline and postoperatively. Results:. A total of 250 patients were included (81 affected and 169 unaffected). Mean age at surgery was 17.9 ± 2.0 and 18.1 ± 1.8 years for affected and unaffected patients, respectively. Anxiety (n = 59, 23.6%) and depression (n = 38, 15.2%) were the most prevalent conditions. Affected patients were outscored by controls at baseline and postoperatively in most measures. However, significant score improvements were also reported in the affected cohort. In fact, the magnitude of score improvements observed in both cohorts were similar (P > 0.05, all). Conclusions:. Baseline mental health conditions are common in young patients presenting for reduction mammaplasty. After surgery, health-related quality of life in affected patients remains below unaffected peers; however, significant and similar gains are achieved. We advise providers to recommend mental health treatment to affected patients, but not preclude otherwise appropriate candidates from surgery

Trends in Outcomes and Variation by Race and Ethnicity in Pediatric Plastic Surgery in the United States

Background:. The American College of Surgeons' National Surgical Quality Improvement Project-Pediatric Data manages a multicenter dataset for monitoring outcomes in pediatric surgical care. We explored trends in outcomes in the most frequently sampled current procedural terminology codes related to craniofacial and cleft lip and palate (CLP) surgical procedures over a 7-year period. Methods:. We used National Surgical Quality Improvement Project-Pediatric Data on 28,147 pediatric patients who underwent plastic surgical procedures between January 1, 2012, and December 31, 2018. Eighteen relevant current procedural terminology codes were selected and sorted into two procedure groups: CLP and craniofacial. For each group, we explored trends in readmission, reoperation, extended length of stay, morbidity, and racial and ethnic variation. Results:. The proportion of readmissions following CLP repair saw a significant reduction per year (from 3.6% to 1.7%). African American or Black CLP patients had significantly higher rates of readmission and extended length of stay when compared to the overall cohort. Asian and White CLP patients had significantly lower rates of experiencing an extended length of stay. For craniofacial cases, extended length of stay decreased significantly per year (from 7.7% to 2.8%). One possible driver of this change was a decrease in transfusion rates during the study period from 59% to 47%. Conclusions:. Pediatric CLP and craniofacial cases saw significant improvements in safety, as indicated by reductions in readmission and extended length of stay. Given the racial differences observed, especially among CLP patients, continued research to identify and address systems of racism in health care remains a priority