Ann Plast Reconstr Surg | Volume 7, Issue 2 | Research Article | Open Access

Unsuitable Referrals to Plastic Surgery: A Single- Institution Review on Unsuitable Breast Reduction and Body Contouring Candidates and Its Impact on Surgeon and Patient

Andrade E1*, Thuman J2, Herrera FA1,2, Armstrong M1,2 and Scomacao IR1,2

1College of Medicine, Medical University of South Carolina, USA
2Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, USA

*Correspondance to: Erika Andrade 

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Background: The purpose of this study is to review our institution’s experience over a one-year period of all patients prematurely referred to plastic surgery for Bilateral Breast Reduction (BBR) and body contouring procedures, and to identify the impact on both patient and surgeon in regards to time, finances, and surgical conversion rates.
Methods: A single-institution, two-surgeon retrospective analysis was performed between January 2022 and January 2023. Patients included in this study were seen as referrals for BBR and body contouring at our institution during this time period. The population was divided into two cohorts: “approved surgery” and “denied surgery.” Demographics, comorbidities, referring persons/ providers, time and cost of the visit, distance and time patients spent driving, and patients who returned to clinic as suitable candidates for surgery were collected. Chi-square and two-tailed T-test analyses were performed on IBM SPSS™.
Results: A total of 155 patients were included. Mean age and Body Mass Index (BMI) were 36 ± 14.67 years and 31 ± 4.81 kg/m2, respectively. 39 (25.16%) patients were denied surgery on the basis of BMI>35 kg/m2 and/or uncontrolled comorbidities. 64.10% (25) of referrals denied surgery came from non-surgical subspecialties, most commonly Family Medicine (13). Patients denied surgery drove 103.12 miles on average (range, 10-414 miles) for an average of 119 min (range, 20-384 minutes) spent driving round-trip. Estimated time spent on non-surgical consults ranged between 15 min to 74 min and 64.10% of clinic visits lasted >45 minutes. At our institution, Current Procedural Terminology (CPT) code 19318 is used for breast reduction and corresponds to 16.03- 17.6 Relative Value Units (RVUs). There was a 2.56% (1) conversion rate of patients denied surgery at the time of initial BBR consultation who successfully controlled their comorbidities and returned to undergo breast reduction, which translates to approximately 475.2 potential RVUs had these BBR consultations been suitable surgical candidates.
Conclusion: Many providers refer patients prematurely to plastic surgery for evaluation of BBR and body contouring procedures, and within a single year many of these patients are denied surgery. Very few of these patients return as suitable candidates for surgery. This results in significant financial and temporal impacts to the patient, provider, and institution. Our study conveys the importance of adhering to general health guidelines and the need for further education on surgical suitability for elective-type surgeries for other subspecialties.




Andrade E, Thuman J, Herrera FA, Armstrong M, Scomacao IR. Unsuitable Referrals to Plastic Surgery: A Single- Institution Review on Unsuitable Breast Reduction and Body Contouring Candidates and Its Impact on Surgeon and Patient. Ann Plast Reconstr Surg. 2023; 7(2): 1109..

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