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Analysis of Breast Reduction Complications Derived from the BRAVO Study

Cunningham, Bruce L. M.D., M.S.; Gear, Andrew J. L. M.D.; Kerrigan, Carolyn L. M.D.; Collins, E Dale M.D.

Plastic and Reconstructive Surgery: May 2005 - Volume 115 - Issue 6 - p 1597-1604
doi: 10.1097/01.PRS.0000160695.33457.DB
Original Articles: Breast

Background: Analysis of complication data derived from the Breast Reduction Assessment: Value and Outcomes (BRAVO) study, a 9-month prospective, multicenter trial, is presented.

Methods: Data derived from 179 patients were analyzed, including bivariate associations between complications and single predictor variables (Fisher's exact test or chi-square testing) or continuous variables (two-sample t test) and, finally, logistic regression.

Results: The overall complication rate was 43 percent (77 patients). Simple, bivariate analysis linked preoperative breast volume, shoulder strap grooving, and a vertical incision with an increased incidence of complications (p < 0.05, 0.02, and 0.02, respectively). Delayed wound healing, the most common complication, correlated directly with average preoperative breast volume (p < 0.045), average resection weight/breast (p < 0.027), and smoking (p < 0.029) and inversely with age (p < 0.011). Vertical incision techniques were associated with an increased complication frequency (p < 0.05) without a link to specific complications. Logistic regression analysis associated resection weight as the sole variable for increased risk of complications (p = 0.05) and with absolute number of complications [mean resection weight of 791 g for patients without complications versus 847, 882, and 1752 g for patients with one, two, and three complications, respectively (p = 0.0022)]. Each 10-fold increase in resection weight increased the risk of complication 4.8 times and increased the risk of delayed healing 11.6 times.

Conclusions: Complication data revealed several significant features: (1) resection weight correlated with increased risk and absolute number of complications; (2) delayed healing correlated directly with resection weight and inversely with increasing age, anesthesia times, and preoperative Short Form-36 bodily pain score; (3) a vertical incision may be associated with increased incidence of complications but requires further analysis; and most importantly, (4) the presence of complications had no negative effect on improvement in Short Form-36 and Multidimensional Body-Self Relations Questionnaire scores.

Minneapolis, Minn.; and Lebanon, N.H.

From the Division of Plastic Surgery, University of Minnesota, and the Section of Plastic Surgery, Dartmouth Hitchcock Medical Center.

Received for publication March 18, 2004; revised June 18, 2004.

Bruce Cunningham, M.D., M.S., Division of Plastic and Reconstructive Surgery, University of Minnesota, Mayo Mail Code 122, 420 Delaware Street SE, Minneapolis, Minn. 55455

©2005American Society of Plastic Surgeons