Current trends in breast reduction: an international analysis

Breastand reductions mastopexies continue to rank among the most frequently performed plastic surgical procedures worldwide. While there exists a consensus on several aspects of the procedure, a plethora of controversies remain. This study aims to compare the most relevant peri- and intra-operative factors on an international level to standardize this common procedure according to evidence-based guidelines. A questionnaire was sent to over five thousand surgeons in 77 countries. The survey was divided into three categories according to the volume of removed breast tissue (50–500 g, 500–1000 g, and > 1000 g) and inquired about standard practices, secondary procedures, use of new technologies, current controversies, and surgeon demographics. The results were evaluated and correlated with evidence-based literature. A total of 1431 surveys were gathered, corresponding to a response rate of 29%. It was found that specific surgical approaches and standard practices prevail on an international basis. Still, there exist controversies that seem to be linked to geographic locations. For instance, irrespective of resection weight, in the majority of countries, a superior or superomedial pedicle is used most frequently, while in North America and South East Asia, the inferior-based pedicle is preferred. We identified common traits in several aspects of breast reduction surgery. However, in this study, it became apparent that international practice patterns remain incoherent. Seen from a global perspective, plastic surgeons would thus still benefit from high-quality studies to further establish evidence-based, standardized, and universally applicable practice guidelines. Level of Evidence: Not gradable