Plast Reconstr Surg. 2022 Jul 22. doi: 10.1097/PRS.0000000000009532. Online ahead of print.
BACKGROUND: Multiple studies have analyzed the impact of co-morbidities on breast reduction surgery with mixed results. The purpose of this investigation was to perform a statistical analysis of all complications by a single surgeon, using a single technique for breast reduction.
METHODS: Records of patients undergoing breast reduction from 1984 to 2019 with an inferior pedicle were reviewed. Co-morbidities analyzed included hypertension, diabetes, nicotine use, weight of breast tissue resected, pedicle length and basal metabolic index. The literature on the effects of comorbidities on outcomes for breast reconstruction were also reviewed.
RESULTS: Although increasing BMI significantly increased the rate of fat necrosis, it did not impact those patients requiring reoperation for this complication. BMI greater than 35, weight of tissue resection greater than 1000gm, and nipple to inframammary fold distance greater than 20cm all increased the odds ratio of having a breast with some fat necrosis. Increasing BMI increased the risk of wound healing problems (both major and minor), but not for patients requiring reoperation. BMI greater than 35, breast tissue resection greater than 1000gm, and nipple to fold distance greater than 20 only minimally increased the odds ratio for a major wound complication.
CONCLUSIONS: Patients with increased BMI are at greater risk for fat necrosis and wound healing complications. However, these usually can be managed conservatively in patients undergoing inferior pedicle breast reduction. Patients do not require free nipple grafting. The use of nicotine, presence of diabetes or hypertension does not impact outcome.