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An Outcomes Analysis of 2142 Breast Reduction Procedures

Manahan, Michele Ann MD*; Buretta, Kate J. BA*; Chang, David PhD, MPH, MBA; Mithani, Suhail K. MD; Mallalieu, Jesse PA*; Shermak, Michele A. MD*

doi: 10.1097/SAP.0b013e31829d2261
Breast Surgery
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Background Breast reduction alleviates macromastia symptoms and facilitates symmetrical breast reconstruction after cancer treatment. We investigated a large series of consecutive breast reductions to study important factors that impact outcomes.

Methods An institutional review board–approved, retrospective review of all breast reductions from 1999 to 2009 in a single institution was performed using the medical record for demographics, medical history, physical examination, intraoperative data, and postoperative complications. Multivariate statistical analysis was performed using Stata 1.0. P ≤ 0.05 defined significance.

Results Seventeen surgeons performed 2152 consecutive breast reductions on 1148 patients using inferior pedicle/Wise pattern (56.4%), medial pedicle/Wise pattern (16.8%), superior pedicle/nipple graft/Wise pattern (15.1%), superior pedicle/vertical pattern (11.6%), and liposuction (0.1%) techniques. Complications included discernible scars (14.5%), nonsurgical wounds (13.5%), fat necrosis (8.2%), infection (7.3%), wounds requiring negative pressure wound therapy or reoperation (1.4%), and seroma (1.2%). Reoperation rates were 6.7% for scars, 1.4% for fat necrosis, and 1% for wounds.

Body mass index greater than or equal to 35 kg/m2 increased risk of infections [odds ratio (OR), 2.3, P = 0.000], seromas (OR, 2.9, P = 0.03), fat necrosis (OR, 2.0, P = 0.002), and minor wounds (OR, 1.7, P = 0.001). Cardiac disease increased reoperation for scar (OR, 3.0, P = 0.04) and fat necrosis (OR, 5.3, P = 0.03). Tobacco use increased infection rate (OR, 2.1, P = 0.008). Secondary surgery increased seromas (OR, 12.0, P = 0.001). Previous hysterectomy/oophorectomy increased risk of wound reoperations (OR, 3.4, P = 0.02), and exogenous hormone supplementation trended toward decreasing infections (OR, 0.5, P = 0.08). χ2 analysis revealed 7.8% infection risk without exogenous hormone versus 3.8% risk with hormone supplementation (P = 0.02).

Conclusions Morbid obesity, tobacco, cardiac history, and secondary surgery negatively impacted breast reduction outcomes. Hormonal status impacted reoperations and infections.

From the *Department of Plastic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD; †Department of Surgery, University of San Diego, San Diego, CA; and ‡Department of Plastic Surgery, Duke University, Durham, NC.

Received September 17, 2012, and accepted for publication, after revision, May 22, 2013.

Presented at the Annual American College of Surgeons (ACS) Meeting, October 2010, Washington, DC.

Conflicts of interest and sources of funding: none declared.

Reprints: Michele Ann Manahan, MD, Department of Plastic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline St, Baltimore, MD 21287. E-mail: mmanahan@jhmi.edu.

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