title: Standardizing the complication rate after breast reduction using the Clavien-Dindo classification.
abstract: Published complication rates for breast reduction surgery, also known as reduction mammaplasty, vary between 4% and 54%. This wide range of complication rates could be attributable to the lack of a standardized classification of complications in plastic surgery. The aim of this study was to analyze our single-center complication rates after reduction mammaplasty using the Clavien-Dindo classification.
  
  
  
  We performed a retrospective chart review studying 804 patients between the ages of 18 and 81 years old who underwent breast reduction between 2005 and 2015 at our institution. Patients with a history of breast cancer, a previous breast operation, who did not undergo bilateral reduction mammaplasty, or who required systemic immunodeficiency/immunosuppressive drugs were excluded from our analysis. Complications were classified according to the Clavien-Dindo classification from Grades I to V.
  
  
  
  A total of 486 patients met the inclusion criteria for the analysis. Patients had an age (mean ± standard deviation) of 39 ± 13 years and a body mass index of 26 ± 4 kg/m2. Median follow-up was 274 days (interquartile range: 90.5-378). The overall rate of complications of reduction mammaplasty was 63%, with the majority of those being Grades I (48%) and II (9%), comprising 92% of all the complications. Operative revisions were required in 6% (1% Grade IIIA and 5% Grade IIIB). There were no complications graded in categories IV and V.
  
  
  
  Although complications occurred in more than half of the cases, the majority did not require operative reintervention. The Clavien-Dindo classification can classify the severity of complications and serve as a benchmark to compare complication rates between different practices. We believe that grading of complications should distinguish between those that do and do not require operative reinterventions.
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria. Electronic address: r.winter@medunigraz.at.
authors.forename: Raimund
authors.initials: R
authors.lastname: Winter
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Isabella
authors.initials: I
authors.lastname: Haug
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lebo
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Grohmann
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Frederike M J
authors.initials: FMJ
authors.lastname: Reischies
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Janos
authors.initials: J
authors.lastname: Cambiaso-Daniel
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Tuca
authors.affiliation: Institute of Health Care Engineering with European Notified Body of Medical Devices, Graz University of Technology, Graz, Austria.
authors.forename: Theresa
authors.initials: T
authors.lastname: Rienmüller
authors.affiliation: Institute of Statistics, Graz University of Technology, Graz, Austria.
authors.forename: Herwig
authors.initials: H
authors.lastname: Friedl
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Spendel
authors.affiliation: University of Texas Medical Branch, School of Medicine, Galveston, TX.
authors.forename: Abigail A
authors.initials: AA
authors.lastname: Forbes
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Wurzer
authors.affiliation: Division of Plastic, Aesthetic, and Reconstructive Surgery, Medical University of Graz, Graz, Austria; Research Unit for Safety in Health, Medical University of Graz, Graz, Austria.
authors.forename: Lars-P
authors.initials: LP
authors.lastname: Kamolz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult