Aesthetic Breast Surgery and Concomitant Procedures: Incidence and Risk Factors for Major Complications in 73,608 Cases.
Major complications following aesthetic breast surgery are uncommon and thus assessment of risk factors is challenging.



To determine the incidence and risk factors of major complications following aesthetic breast surgery and concomitant procedures.



A prospective cohort of patients who enrolled into the CosmetAssure (Birmingham, AL) insurance program and underwent aesthetic breast surgery between 2008 and 2013 was identified. Major complications (requiring reoperation, readmission, or emergency room visit) within 30 days of surgery were recorded. Risk factors including age, smoking, body mass index (BMI), diabetes, type of surgical facility, and combined procedures were evaluated.



Among women, augmentation was the most common breast procedure (n = 41,651, 58.6%) followed by augmentation-mastopexy, mastopexy, and reduction. Overall, major complications occurred in 1.46% with hematoma (0.99%) and infection (0.25%) being most common. Augmentation-mastopexy had a higher risk of complications, particularly infection (relative risk [RR] 1.74, P < 0.01), than single breast procedures. Age was the only significant predictor for hematomas (RR 1.01, P < 0.01). Increasing age (RR 1.02, P = 0.03) and BMI (RR 1.09, P < 0.01) were risk factors for infection. Concomitant abdominoplasty was performed in 4162 (5.8%) female patients and was associated with increased risk of complications compared to breast procedures or abdominoplasty performed alone. Among men, correction of gynecomastia was the most common breast procedure (n = 1613, 64.6%) with a complication rate of 1.80% and smoking as a risk factor (RR 2.73, P = 0.03).



Incidence of major complications after breast cosmetic surgical procedures is low. Risk factors for major complications include increasing age and BMI. Combining abdominoplasty with any breast procedure increases the risk of major complications.



2.
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Varun
V
Gupta
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Max
M
Yeslev
Plastic Surgery Fellow, Division of Plastic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
Julian
J
Winocour
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Ravinder
R
Bamba
Resident, Department of Plastic Surgery, University of Washington, Seattle, WA, USA.
Charles
C
Rodriguez-Feo
Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL, USA.
James C
JC
Grotting
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
K Kye
KK
Higdon
D061645:Abdominoplasty / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D066264:Datasets as Topic; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult