Characterization of Breast Deformities After Massive Weight Loss: Utilizing the Pittsburgh Rating Scale
John Pang, MD, Demetrius Coombs, BS, Isaac B. James, MD, Jordan Fishman, MD, J Peter Rubin, Jeffrey A. Gusenoff, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND: Massive weight loss (MWL) can result in variable contour deformities of the breasts. The Pittsburgh Rating Scale (PRS) was designed to describe the multitude of deformities after MWL. We present the first comprehensive description of breast deformities in a large sample of MWL patients.
METHODS: A retrospective review of all MWL patients presenting for breast surgery at our institution's Life After Weight Loss program from 2004-2015 was performed. Demographics, body mass indices, method of weight loss, and type of surgical intervention were collected. Preoperative breast photographs were blinded and scored according to the PRS.
RESULTS: 204 MWL patients were identified. 26%(53) scored 1, 34%(69) scored 2, and 40%(82) scored 3 on the PRS. Greater deformities were seen following weight loss from bariatric surgery versus diet and exercise alone (p=0.031), in mastopexy versus augmentation/mastopexy(p=0.001), and in breast reduction versus augmentation/mastopexy patients (p>0.0001). Patients who underwent reduction had the greatest maximum-BMI compared to other procedures (p=0.016). PRS scores were positively correlated to maximum-BMI (p<0.001), delta-BMI (p<0.001), and current-BMI (p<0.001).
CONCLUSIONS: MWL patients have variable breast deformities, and the Pittsburgh Rating Scale remains a valuable classification tool. Scores correlate with BMI, procedure, and weight loss mechanism. Similar scores between mastopexy-only and reduction patients may reflect a composite of personal cosmetic expectations and cost. Understanding breast deformities in this population has applications in preoperative planning and surgical expectations.
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