title: An outcomes analysis of 2142 breast reduction procedures.
abstract: BACKGROUND
  Breast reduction alleviates macromastia symptoms and facilitates symmetrical breast reconstruction after cancer treatment. We investigated a large series of consecutive breast reductions to study important factors that impact outcomes.
  
  
  METHODS
  An institutional review board-approved, retrospective review of all breast reductions from 1999 to 2009 in a single institution was performed using the medical record for demographics, medical history, physical examination, intraoperative data, and postoperative complications. Multivariate statistical analysis was performed using Stata 1.0. P ≤ 0.05 defined significance.
  
  
  RESULTS
  Seventeen surgeons performed 2152 consecutive breast reductions on 1148 patients using inferior pedicle/Wise pattern (56.4%), medial pedicle/Wise pattern (16.8%), superior pedicle/nipple graft/Wise pattern (15.1%), superior pedicle/vertical pattern (11.6%), and liposuction (0.1%) techniques. Complications included discernible scars (14.5%), nonsurgical wounds (13.5%), fat necrosis (8.2%), infection (7.3%), wounds requiring negative pressure wound therapy or reoperation (1.4%), and seroma (1.2%). Reoperation rates were 6.7% for scars, 1.4% for fat necrosis, and 1% for wounds.Body mass index greater than or equal to 35 kg/m increased risk of infections [odds ratio (OR), 2.3, P = 0.000], seromas (OR, 2.9, P = 0.03), fat necrosis (OR, 2.0, P = 0.002), and minor wounds (OR, 1.7, P = 0.001). Cardiac disease increased reoperation for scar (OR, 3.0, P = 0.04) and fat necrosis (OR, 5.3, P = 0.03). Tobacco use increased infection rate (OR, 2.1, P = 0.008). Secondary surgery increased seromas (OR, 12.0, P = 0.001). Previous hysterectomy/oophorectomy increased risk of wound reoperations (OR, 3.4, P = 0.02), and exogenous hormone supplementation trended toward decreasing infections (OR, 0.5, P = 0.08). χ analysis revealed 7.8% infection risk without exogenous hormone versus 3.8% risk with hormone supplementation (P = 0.02).
  
  
  CONCLUSIONS
  Morbid obesity, tobacco, cardiac history, and secondary surgery negatively impacted breast reduction outcomes. Hormonal status impacted reoperations and infections.
authors: From the *Department of Plastic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD; †Department of Surgery, University of San Diego, San Diego, CA; and ‡Department of Plastic Surgery, Duke University, Durham, NC.
authors: Michele Ann
authors: MA
authors: Manahan
authors: Kate J
authors: KJ
authors: Buretta
authors: David
authors: D
authors: Chang
authors: Suhail K
authors: SK
authors: Mithani
authors: Jesse
authors: J
authors: Mallalieu
authors: Michele A
authors: MA
authors: Shermak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult