title: Smoking as a risk factor for breast reduction: An analysis of 13,503 cases.
abstract: BACKGROUND
  Reduction mammaplasty is one of the most common reconstructive procedures performed by plastic surgeons. Over 100,000 procedures are performed annually. Although important for relieving the painful symptoms associated with macromastia, complication rates of this procedure are not insignificant. They are reported in up to half the cases. Reported risk factors for adverse outcomes include obesity, preoperative wound infection, and advanced American Society of Anesthesiologists status. Smoking has been described as a risk factor for breast reduction. There is disagreement in the literature regarding the effect of smoking on patient outcomes. To further describe and investigate smoking as a risk factor, we undertook the largest multicenter retrospective study on this subject.
  
  
  METHODS
  Data on 13,984 patients was identified from the 2009-2014 American College of Surgeons National Surgical Quality Improvement Program. Smoker and nonsmoker cohorts were compared to assess unadjusted differences in demographics, comorbidities, intraoperative details, 30-day outcomes, and readmission rates. Univariate analysis was performed using chi-square or Fisher's exact and Wilcoxon signed-rank tests. A multivariate logistic regression model was created to identify independent risk factors for complications and readmission. Odds ratios were computed at the 95% confidence interval.
  
  
  RESULTS
  After adjusting for potential confounders, smokers had a higher likelihood of any wound complication (OR 1.72; p = 0.001) following reduction mammaplasty compared to nonsmokers.
  
  
  CONCLUSIONS
  Smoking has been shown to be a significant risk factor for wound complications following reduction mammaplasty. Comprehensive preoperative counseling and documentation should be performed with patients who smoke regarding the potential for increased risk of adverse outcomes.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine, University of Miami, USA. Electronic address: jeffery.hillam@med.miami.edu.
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Hillam
authors.affiliation: Department of Plastic Surgery, University of California, Irvine, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Borsting
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine, University of Miami, USA.
authors.forename: Jimmy H
authors.initials: JH
authors.lastname: Chim
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Leonard M. Miller School of Medicine, University of Miami, USA.
authors.forename: Seth R
authors.initials: SR
authors.lastname: Thaller
mesh_terms: D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D008297:Male; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
keywords: Breast reduction; Macromastia; NSQIP; National Surgical Quality Improvement Program; Reduction mammaplasty; Smoking