The Utility of the Schnur Sliding Scale in Adolescent Patients

Jonah I Donnenfield; Laura C Nuzzi; Catherine T McNamara; Ava G White; Brian I Labow

doi:10.1097/PRS.0000000000011083

The Utility of the Schnur Sliding Scale in Adolescent Patients

Plast Reconstr Surg. 2023 Sep 25. doi: 10.1097/PRS.0000000000011083. Online ahead of print.

Authors

Jonah I Donnenfield^{1

2}, Laura C Nuzzi^{1

2}, Catherine T McNamara^{1

2}, Ava G White^{1

2}, Brian I Labow^{1

2}

Affiliations

¹ Adolescent Breast Center, Boston Children's Hospital and Harvard Medical School, Boston, MA.
² Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.

PMID: 37747419
DOI: 10.1097/PRS.0000000000011083

Abstract

Background: Although the Schnur Sliding Scale (SSS) was not intended to be utilized by third-party payors, it has become the national standard for coverage decisions regarding macromastia treatment in women of all demographics. Adolescents were neither included in the cohort that created the SSS, nor have they been represented in subsequent validation studies.

Methods: In this prospective study, health-related quality of life surveys were administered to adolescent females aged 12 to 21 years of age, before and after undergoing reduction mammaplasty to treat macromastia. The SSS was used to preoperatively estimate the amount of tissue to be resected. Before and after surgery, subjects completed the Short Form-36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), Breast-Related Symptoms Questionnaire (BRSQ), and Eating Attitudes Test-26. Demographic data were compared, and linear regressions evaluated the effect of resection amounts meeting the SSS value on survey scores.

Results: Resection amounts fell below the SSS for 39 patients and above the SSS for 255 patients. Groups featured no difference in mean age or BMI. Both groups had significant postoperative survey score improvements on the RSES, BRSQ, and in 7/8 SF-36 domains (P < .05, all). Both groups had comparable postoperative survey scores on the RSES, BRSQ, and in 8/8 SF-36 domains (P > .05, all).

Conclusions: Adolescents undergoing reduction mammaplasty above and below the SSS experienced comparable physical and psychosocial benefits. These findings underscore the need for third-party payors to broaden coverage for adolescent reduction mammaplasty, as the common coverage cutoff has no impact on overall postoperative benefit.