The contribution of breast and abdominal pannus weight to body mass index: implications for rationing of reduction mammaplasty and abdominoplasty.

The body mass index (BMI) is an arbitrary criterion used by third party fundholders in some countries for rationing the public funding of reduction mammaplasty and abdominoplasty surgery. Many patients have commented that the weight of their excess breast tissue or abdominal pannus contributes to an overestimation of their body mass index. This study seeks to establish the truth of this by ascertaining whether the difference between pre- and postoperative body mass indices of patients undergoing reduction mammaplasty or abdominoplasty is significant. Case notes of 30 sequential reduction mammaplasty patients and 16 abdominoplasty patients were analyzed to ascertain their preoperative weight, height, calculated BMI, and the mass of the breast reduction or abdominal resection specimen as measured in theater. This information was used to retrospectively calculate the difference the weight of the specimen would have made to their BMI. Overall, the difference between pre- and postoperative BMI is not statistically significant (reduction mammaplasty P = 0.22; abdominoplasty P = 0.62, 2-tailed t test). However, the largest contribution breast reduction and abdominoplasty resection specimens made to the BMI in our series was 1 and 2.4, respectively. We suggest that it may be appropriate to consider a minority of patients for surgery if their BMI is within 1.0 (for breast reduction) or 2 (for abdominoplasty) of any set target BMI, and highlight the specific patient subpopulations to which this is most applicable. An estimate of resection weight preoperatively may allow a "corrected" BMI to be used for determining eligibility for surgery.