Breast Reduction for Symptomatic Macromastia: A 10-Year Retrospective Analysis
Breast reductions are one of the most common plastic surgery procedures in the US, with 46,591 breast reductions performed in 2019 (1). In order to meet insurance qualifications for surgery, criteria have been set forth in relation to patient body mass index and amount necessary to resect. There is an exuberant amount literature and wide data regarding BMI as it is related to breast reduction complications (3,4,5).
In the US in 2018, 42.5% of the adult population over 20 years old was obese and 73.6% had a BMI equal or greater than 25 (>overweight)(2). With a predominately overweight population, the need for evidence-based data regarding complications and outcomes from breast reductions in this population is essential. The aim of this study is to characterize the population of patients undergoing bilateral breast reduction and evaluate outcomes while stratifying the population based on patient’s BMI at a single institution.
Methods/Technique:
A retrospective review of bilateral breast reductions performed at a single institution from January 2010 to December 2020 was performed. Female patients older than 16 years of age with symptomatic macromastia were included. Demographics, comorbidities, sternal notch to nipple distance, pedicle technique, resection weight, complications, and drain duration were reviewed. Patients were divided into 5 groups depending on their BMI (group 1: BMI<25, group 2: BMI 25-30, group 3: BMI >30-35, group 4: BMI >35-40, group 5: BMI>40). Krukall Wallis test, Chi square test, and multivariate logistic regression were performed.
Results/Complications:
A total of 882 patients for a total of 1720 breasts were included. The mean age of patients was 42 years ± 15.6. The mean sternal notch-nipple distance was 33.5cm ± 5.46 with average specimen weight being 921.95 g ± 535.02 and inferior pedicle technique was the most commonly performed (87.96%). Forty-eight percent of patients had one or more comorbidities and 219 patients had complications. Using a multivariant Logistic regression linear correlations were found between BMI and resection weight, and BMI and sternal notch to nipple distance. Patients with BMI>40 had significantly more wound dehiscence than the other BMI groups (p=0.05). Dehiscence at the IMF was significantly more frequent in patients with BMI >30 (p=0.03), as well as partial NAC necrosis (p=0.043). Patients with BMI<25 were found to have shorter drain duration than obese and morbidly obese patients (p=0.024 and p=0.028 respectively).
Conclusion:
The risk of complications in patients undergoing bilateral breast reduction is significantly higher in patients with BMI equal or greater than 40. There is also a notable linear correlation between BMI and resection weight, as well as BMI and sternal notch to nipple distance. More research is necessary to further quantify this correlation as it is related to the breast reduction population, rather than a single institution.