ABSTRACT

America's obese population is increasing and plastic surgeons are faced with patients requesting larger breast reductions. A large number of women seeking this operation have body mass indices in the obese to morbidly obese range (30 - >40 kg/m2, respectively) and their breasts are considered gigantomastic (>2000 g of breast tissue resected from each breast). To date, there have been few descriptions of breast reduction complications in the morbidly obese population, and previous literature reports high complication rates in obese women and women undergoing large volume breast reductions.

METHODS: A retrospective investigation of 179 reduction mammaplasty patients was carried out to determine how reduction size, age, body mass index, smoking status, operation performed, and the presence of comorbidities influenced complication rates. The patients were categorized by size of reduction into five groups (<500 g per side, 500-999 g, 1000-1499 g, 1500-1999 g, and >2000 g), by age into five categories (spanning <20 to >50), by body mass index into four categories (normal, BMI 18-24.9, overweight, BMI 25-29.9, obese, BMI 30-39.9, and morbidly obese, BMI > 40), into smokers and nonsmokers, and categorized by the type of operation they received (vertical, central mound/inferior pedicle, and breast amputation with free nipple graft.) These groups were then comparatively analyzed for incidence of complications and comorbidities. Data were analyzed using Chi-square analysis, Fisher exact test, and Cochran-Mantel-Haenszel model when appropriate.

RESULTS: The overall complication rate for our patient population was 50%, delayed healing being the most prevalent, followed by cellulitis and hypertrophic scarring. There was no statistical difference in the incidence of complications as a result of size of reduction, age, or body mass index (p=0.37, 0.13, and 0.38 respectively). There was also no statistically significant difference in the rate of complications in any of the patient groups in women with comorbidities (reduction size, p=0.054, age, p=0.12, and BMI, p=0.072). As well, there was no significant increase in the rate of complications for each body mass index group based on their reduction size (p=0.75, 0.89, 0.23, and 0.07). There was no difference in complications in the smokers when controlling for their reduction mass and their BMI (p= 0.65 and 0.17 respectively). There was also no difference in complication rates based on the type of operation performed in either the reduction mass groups or the BMI groups (p=0.48 and 0.1 respectively.)

CONCLUSION: Thus, we conclude there is no association between increased reduction size, age, or body mass index, including morbid obesity, smoking status, or type of operation with complications. There is no propensity towards complications in women with comorbidities, nor is there any association of complications with BMI and increasing reduction size. Hence, it is safe to perform large volume breast reductions even in the morbidly obese patient with comorbidities.