Reductio ad Absurdum: Examining the Validity of the 500-Gram Rule in Reduction Mammaplasty.

Background: Reduction mammaplasty is a common procedure associated with a very high patient satisfaction rate. It has been shown to alleviate symptoms related to macromastia, such as back, neck, and shoulder pain, poor posture, bra strap grooving, paresthesia, and rashes. Despite the manifold benefits of reduction mammaplasty, some insurance companies require minimum resection weights of at least 500 g per breast in order to distinguish between a reconstructive and aesthetic procedure.

Objectives: The aim of this study was to assess the origins of the 500-g rule used in reduction mammaplasty.

Methods: A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, the Cochrane Central Register of Controlled Trials databases was conducted for studies published through July 2020 with multiple search terms related to resection weight criteria for breast reduction. Data on criteria, outcomes, and patient satisfaction were collected.

Results: A total of 14 articles were selected from the 27 articles that were identified. The 500-g rule appears to be arbitrary, and not based on any available hard evidence. However, numerous studies show that patients who have less than 500 g of tissue removed from each breast still experience significant symptomatic relief from reduction mammaplasty with a marked improvement in their quality of life.

Conclusions: The 500-g rule should be re-evaluated as an insurance company criterion for authorizing reduction mammaplasty. The rule may influence surgeons to choose between form and function. Many additional patients might then benefit from this important procedure.