Hipertrofia mamária: avaliação da qualidade de vida, satisfação e custoutilidade das mamoplastias redutoras no serviço de saúde pública brasileiro

Abstract

Patients who have breast hypertrophy are more vulnerable to decreased self-esteem, an impaired sexual life, depression and anxiety. The true prevalence of breast hypertrophy was not evaluated; however, breast reduction is one of the most performed surgical procedures by plastic surgeons around the world. The evaluation of the improvement in the quality of life of patients who underwent reduction mammoplasty has become necessary since the development of the technique, as a way to evaluate its use in patients with breast hypertrophy. In order to be able to measure, if there is a change in the level of quality of life in patients submitted to reductive mammoplasty, several forms of evaluation were developed. The patient's satisfaction and health-related quality of life have become important tools for evaluating the outcomes and success of both cosmetic and reconstructive breast surgery. Breast-Q® is an instrument for assessing body image and quality of life in patients undergoing breast surgery and its data were used to evaluate both the quality of life and the patient's satisfaction in several aspects as well as to calculate cost-utility. Costs with health care have undergone large increases in the last ten years. This rising expenditure has led health policy managers to allocate resources more efficiently. Plastic surgery is often criticized for costly interventions with little impact on Life expectancy. However, while plastic surgery interventions may extend life in certain circumstances, the deeper impact on our patients is often an improvement in quality of life. The objective of this study is to evaluate the quality of life and satisfaction of patients with moderate mammary hypertrophy to gigantomastia, in the pre and postoperative period and also to assess the cost-utility of the reduction mammaplasty. A prospective cohort study was performed, when 83 patients underwent surgery, with the results pointing to statistically significant improvements in the satisfaction not only with her breasts, bit also in the psychosocial, physical and sexual well-being. The total cost of the treatment took into account the exams, surgery and medications used in the postoperative period, in addition to all medical appointments performed from the preoperative to the sixth postoperative month, when the patient is considered discharged. All these costs were calculated considering whether the patient was reoperated or not, due to postoperative complications. The cost-utility analysis led us to the following results: patients submitted to surgery and who evolved without complications, the ACU was R$1.109,00/30.56 QALY. In the reoperated group, this value was R$1.665,00/21.49 QALY. The weighted average calculated for all patients who underwent surgery was equal to R$1.153,00/29.8% QALY. The incremental cost-utility ratio that we got in this survey is R$62,20/QALY gain. The results of the present study point to the existence of a significant improvement in the quality of life in patients who underwent breast reduction, both in the physical and psychosocial aspects. Therefore, the development and validation of Breast-Q represent an advance for plastic and reconstructive breast surgery, since this questionnaire provides a specific method to evaluate the results, providing reference for comparison between studies. Facing the need in today 's world for a cost reduction policy, and the lack of brazilian costeffectiveness/utility studies in Plastic Surgery, this sort of should be increasingly performed in order to evaluate interventions in this specialized area, allowing a detailed analysis, to define the quality of the current economic actions and to guide improvements.