title: Comparing breast-reduction techniques: time-to-event analysis and recommendations.
abstract: BACKGROUND
  Breast reduction is a common procedure used to improve physical and aesthetic factors associated with breast hypertrophy. This study investigated how surgical technique alone affects the risk factors for complications and profiled differences between techniques. Complications were assessed by the use of time-to-event methods.
  
  
  METHODS
  Patient information was extracted from a cohort of 283 patients. Demographic, surgical, and follow-up information was analyzed for patients undergoing surgical procedures using the inferior pedicle Wise pattern (IPWP) and modified Hall-Findlay (MHF) techniques. The patients managed with the IPWP technique were considered control subjects. The failure rates were described using the Kaplan-Meier failure estimator to provide a true estimate of the experienced complication rates.
  
  
  RESULTS
  Overall, few differences were noted between the groups except for total tissue removed. The overall failure (complication) rate at 6 months was 18.8%, with 9% of all the patients experiencing a major complication that required operative intervention/revision. As expected, the period with the greatest risk of complication was the first month after surgery. Surgical technique, total tissue removed, and age were nonpredictive of complications. Overall, the IPWP group had significantly more total tissue removed than the MHF group (median difference, 227 g; P=0.002). There was no evidence of a learning curve when an experienced surgeon moved from the one technique to the other.
  
  
  CONCLUSIONS
  At 6 months after surgery, 19% of patients are expected to have experienced a complication. There appears to be few differences in outcomes between the techniques of breast reductions used, and the success or otherwise almost certainly relates to factors independent of surgical technique and includes patient selection, operative skill, and experience. Time-to-event analysis provides a precise assessment and description of the complication profile.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Peninsula Health, P.O. Box 52, Frankston, VIC, 3199, Australia. dhuntersmith@mac.com
authors.forename: D J
authors.initials: DJ
authors.lastname: Hunter-Smith
authors.forename: N R
authors.initials: NR
authors.lastname: Smoll
authors.forename: B
authors.initials: B
authors.lastname: Marne
authors.forename: H
authors.initials: H
authors.lastname: Maung
authors.forename: M W
authors.initials: MW
authors.lastname: Findlay
mesh_terms: D001940:Breast / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors