Outpatient Superior Pole Reduction Mammaplasty:
The authors performed a retrospective study to determine perioperative and long term outcomes for superior pedicle breast reduction in the outpatient setting.
Methods/Technique:
A review of 62 total patients who underwent superior pedicle breast reduction from 1990 to 2013 in a single outpatient center was performed. In these cases, a superior pedicle wise pattern reduction mammoplasty was performed. The patient demographic and surgical data was reviewed along with complication frequency and type and revision rate. Recorded complications included seroma, hematoma, breast cellulitis, standing cone deformity, incisional breakdowns, and nipple areola complex necrosis. The charts were also examined for all other potential complications including need for blood transfusion, deep venous thrombosis, myocardial infarction, and death.
Results/Complications:
The mean patient age was 40 (standard deviation 12.5 years) mean body mass index was 25 (+/- 2.9 kg/m2). Reported bra cup size ranged from 32 D to 40 G, with DD being the most common size. The mean preoperative sternal notch to nipple distance was 27.6 cm (2.8 standard deviation). Twenty nine patients (47%) had some form of preoperative morbidity, including hypothyroidism, obesity and hypertension. Ten patients (16%) were smokers. Mean clinical follow up was 12 months for these patients. Average total resection weight was 406 grams with a standard deviation of 163 grams. The mean operative time for those patients who underwent superior pedicle reduction as the sole procedure was 112 minutes with a standard deviation of 21 minutes. Thirteen patients underwent multiple procedures on the same day, including abdominoplasty, liposuction and facelift with a mean operative time of 170 minutes (standard deviation of 42 minutes). The overall complication rate was 31 % with 19 minor complications occurring, including one hematoma, one standing cone deformity, one case of nipple areolar necrosis, 3 infections, 8 incisional breakdowns and 12 cases of poor scar formation. Incisional breakdowns included areas of the t zone junction (8) and the nipple areolar complex (4). No major complications were recorded. Statistical analysis of the complication data showed there was no significant difference in those undergoing multiple procedures from those undergoing one procedure. Comparison of BMI showed a significant difference between those with and without complications. Those without complications had an average BMI of 24.5 and those with complications had an average BMI of 26.5, P=0.03 (using a paired, 2 tailed student’s t test).
Conclusion:
This large retrospective study examines the safety of outpatient superior pedicle reduction and identifies BMI as an important factor which may predispose patients to complications. Complication data from this outpatient facility is similar to reported outcomes in the literature and this supports the safety and efficacy of outpatient superior pedicle breast reduction in an accredited facility.