title: Postoperative wound infections after breast reductions: the role of smoking and the amount of tissue removed.
abstract: BACKGROUND
  This prospective study followed patients who underwent breast reductions to determine the influence of smoking and the amount of tissue removed on postoperative wound infections.
  
  
  METHODS
  Patients who had received breast reductions were considered eligible for the study. The study excluded postbariatric patients and those with ongoing clinical infections, a recent antibiotic course, or systemic diseases that could impair tissue oxygenation. Smokers were instructed to quit smoking at least 4 weeks before surgery.
  
  
  RESULTS
  By March 2004, the study had enrolled 87 patients. Postoperative infections were present in 24 cases (27.9%). Infections included 16 in smokers (37.2%), 8 in nonsmokers (18.2%; p < 0.05), 14 in patients with large resections (>0.85 kg; 70%), and 10 in patients with small resections (14.9%; p < 0.001). Significant differences were found between the patients who experienced infections and those who were infection free in terms of the overall estimated cigarettes smoked (mean, 146,000; range, 29,200-228,125 vs mean, 10,950; range, 9,125-54,750; p < 0.001), the number of pack years (mean, 20; range, 4-31 vs mean, 2; range, 1-8; p < 0.001), and the amount of tissue removed (mean, 0.9 kg; range, 0.5-2 kg vs mean, 0.5 kg; range, 0.2-1.4 kg; p < 0.001). The analysis for all the patients determined an odds ratio of 2.04 for smoking and 4.7 for the amount of tissue removed.
  
  
  CONCLUSIONS
  Smoking and the amount of tissue removed are important issues in aesthetic breast surgery that need to be addressed accurately by the plastic surgeon. If future larger studies confirm these data, surgeons could have a simple and easy method for stratifying patients according to their risk for the development of wound infections and for prescribing specific preventive measures.
authors.affiliation: Department of General Surgery, Plastic Surgery and Laboratory of Biometry, University of Tor Vergata in Rome, Rome, Italy. ggravante@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Gravante
authors.forename: A
authors.initials: A
authors.lastname: Araco
authors.forename: R
authors.initials: R
authors.lastname: Sorge
authors.forename: R
authors.initials: R
authors.lastname: Caruso
authors.forename: F
authors.initials: F
authors.lastname: Nicoli
authors.forename: F
authors.initials: F
authors.lastname: Araco
authors.forename: D
authors.initials: D
authors.lastname: Delogu
authors.forename: V
authors.initials: V
authors.lastname: Cervelli
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D016462:Mammaplasty / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology*