title: Surgical Timing and the Menstrual Cycle Affect Wound Healing in Young Breast Reduction Patients.
abstract: BACKGROUND
  Young female subjects are known to have the highest baseline menstrual hormone levels of any female age group. Studies have found an association between hormone levels and wound healing. This has been researched in the orthopedic, gynecologic, and dermatologic literature, and more recently, in young patients undergoing augmentation mammaplasty. The purpose of this study was to determine whether the timing of surgery relative to the menstrual cycle plays a role in surgical complications following bilateral reduction mammaplasty.
  
  
  METHODS
  All female patients aged 25 years or younger with a documented last menstrual cycle undergoing a bilateral reduction mammaplasty from 2005 to 2013 were reviewed. Surgical timing and postoperative complications relative to the last menstrual cycle were recorded. The preovulatory phase referred to days 1 to 14 after the patient's last menstrual cycle, whereas the postovulatory phase referred to days 15 to 28.
  
  
  RESULTS
  Forty-nine patients met inclusion criteria. Undergoing bilateral reduction mammaplasty during the postovulatory phase was associated with development of wound dehiscence and hypertrophic scarring (p < 0.005), which were the most common postoperative complications. Surgery in the preovulatory or postovulatory phase did not affect hematoma, seroma, wound infection, or nipple-areolar complex necrosis rates (p > 0.05). Age, race/ethnicity, body mass index, large resection mass, and medical comorbidities did not affect wound dehiscence or scar hypertrophy rates (p > 0.05).
  
  
  CONCLUSIONS
  Young patients undergoing bilateral reduction mammaplasty during the postovulatory phase of the menstrual cycle have an increased risk of wound healing issues and poor scarring. This may be attributable to hormonal fluxes occurring during this phase and the already high hormone levels in this population.
authors.affiliation: Galveston, Texas From the Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch.
authors.forename: Mariela M
authors.initials: MM
authors.lastname: Lopez
authors.forename: Alexander Chase
authors.initials: AC
authors.lastname: Castillo
authors.forename: Kyle
authors.initials: K
authors.lastname: Kaltwasser
authors.forename: Linda G
authors.initials: LG
authors.lastname: Phillips
authors.forename: Clayton L
authors.initials: CL
authors.lastname: Moliver
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008597:Menstrual Cycle / Q000097:blood*; D061646:Operative Time; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014945:Wound Healing; D055815:Young Adult
chemical_list: D012739:Gonadal Steroid Hormones
references.citation: Collins ED, Kerrigan CL, Kim M, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg. 2002;109:1556–1566
references.citation: Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg. 2000;106:991–997
references.citation: Corriveau S, Jacobs JS. Macromastia in adolescence. Clin Plast Surg. 1990;17:151–160
references.citation: Larson K, Gosain AK. Cosmetic surgery in the adolescent patient. Plast Reconstr Surg. 2012;129:135e–141e
references.citation: Cunningham BL, Gear AJ, Kerrigan CL, Collins ED. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg. 2005;115:1597–1604
references.citation: Tsai R, Castillo A, Moliver C. Breast striae after cosmetic augmentation. Aesthet Surg J. 2014;34:1050–1058
references.citation: Cordeiro RC, Zecchin KG, de Moraes AM. Expression of estrogen, androgen, and glucocorticoid receptors in recent striae distensae. Int J Dermatol. 2010;49:30–32
references.citation: Beynnon BD, Shultz SJ. Anatomic alignment, menstrual cycle phase, and the risk of anterior cruciate ligament injury. J Athl Train. 2008;43:541–542
references.citation: Wojtys EM, Huston LJ, Lindenfeld TN, Hewett TE, Greenfield ML. Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes. Am J Sports Med. 1998;26:614–619
references.citation: Wojtys EM, Huston LJ, Boynton MD, Spindler KP, Lindenfeld TN. The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med. 2002;30:182–188
references.citation: Eiling E, Bryant AL, Petersen W, Murphy A, Hohmann E. Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity. Knee Surg Sports Traumatol Arthrosc. 2007;15:126–132
references.citation: Raghunath RS, Venables ZC, Millington GW. The menstrual cycle and the skin. Clin Exp Dermatol. 2015;40:111–115
references.citation: Stranahan D, Rausch D, Deng A, Gaspari A. The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis. Dermatitis. 2006;17:39–42