مجله جهانی جراحی پلاستیک
مجله جهانی جراحی پلاستیک
سه شنبه 28 مهر 1405
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دوره 15، شماره 2 - ( 1405 )
جلد 15 شماره 2 صفحات 78-69 |
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Masoomi H, Liang BA E. Increasing BMI Correlates Directly with Higher Complication Rate in Breast Reduction Surgery. WJPS 2026; 15 (2) :69-78
URL: http://wjps.ir/article-1-1668-fa.html
URL: http://wjps.ir/article-1-1668-fa.html
Increasing BMI Correlates Directly with Higher Complication Rate in Breast Reduction Surgery. مجله جهانی جراحی پلاستیک. 1405; 15 (2) :69-78
چکیده: (663 مشاهده)
Background: Breast reduction improves quality of life for patients with breast hypertrophy in any Body Mass Index (BMI) category. We aimed to evaluate how BMI affected postoperative outcomes of breast reduction using a large nationwide database.
Methods: Using the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database, we examined patients undergoing breast reduction for hypertrophy from 2016 to 2020. Patients who had reductions for symmetry, oncoplastic reconstruction, or combined with panniculectomy were excluded.
Results: A total of 23,171 patients met inclusion criteria. Mean age was 40.7 years, and mean BMI was 31.0 +/- 6.8. Most patients (75%) had BMI<35. Mean operative time was 152 +/- 63 minutes. Overall complication rate was 5.0%, increasing from 2.4% in BMI<25 group to 11.4% in BMI>45. Many complications were related to the surgical site complications (4.4%), rising from 2.4% in BMI<25 to 10.2% in BMI>45. Rates of return to the operating room within 30 days (2.0%), venous thromboembolism (0.2%), urinary tract infection (0.2%), pneumonia (0.1%), and myocardial infarction (0.0%) did not differ significantly across BMI groups.
Conclusion: Higher BMI is associated with increased postoperative complications after breast reduction, primarily due to surgical-site events. However, BMI does not appear to affect rates of medical complications or unplanned returns to the operating room. Given the overall low risk and the benefits of surgery, obesity alone should not exclude patients from reduction mammaplasty. Patients should instead receive individualized risk counseling and assessment.
Methods: Using the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database, we examined patients undergoing breast reduction for hypertrophy from 2016 to 2020. Patients who had reductions for symmetry, oncoplastic reconstruction, or combined with panniculectomy were excluded.
Results: A total of 23,171 patients met inclusion criteria. Mean age was 40.7 years, and mean BMI was 31.0 +/- 6.8. Most patients (75%) had BMI<35. Mean operative time was 152 +/- 63 minutes. Overall complication rate was 5.0%, increasing from 2.4% in BMI<25 group to 11.4% in BMI>45. Many complications were related to the surgical site complications (4.4%), rising from 2.4% in BMI<25 to 10.2% in BMI>45. Rates of return to the operating room within 30 days (2.0%), venous thromboembolism (0.2%), urinary tract infection (0.2%), pneumonia (0.1%), and myocardial infarction (0.0%) did not differ significantly across BMI groups.
Conclusion: Higher BMI is associated with increased postoperative complications after breast reduction, primarily due to surgical-site events. However, BMI does not appear to affect rates of medical complications or unplanned returns to the operating room. Given the overall low risk and the benefits of surgery, obesity alone should not exclude patients from reduction mammaplasty. Patients should instead receive individualized risk counseling and assessment.
فهرست منابع
1. Kupfer D, Dingman D, Broadbent R. Juvenile breast hypertrophy: report of a familial pattern and review of the literature. Plast Reconstr Surg 1992 Aug;90(2):303-9. [DOI:10.1097/00006534-199208000-00023]
2. Baker SB, Burkey BA, Thornton P, LaRossa D. Juvenile gigantomastia: presentation of four cases and review of the literature. Ann Plast Surg 2001 May;46(5):517-25; discussion 525-526. [DOI:10.1097/00000637-200105000-00011]
3. O'Hare PM, Frieden IJ. Virginal breast hypertrophy. Pediatr Dermatol 2000;17(4):277-81. [DOI:10.1046/j.1525-1470.2000.01774.x]
4. Govrin-Yehudain J, Kogan L, Cohen HI, Falik-Zaccai TC. Familial juvenile hypertrophy of the breast. J Adolesc Health 2004 Aug;35(2):151-5. [DOI:10.1016/j.jadohealth.2003.09.017]
5. Zhong A, Wang G, Yang J, Xu Q, Yuan Q, Yang Y, et al. Stromal-epithelial cell interactions and alteration of branching morphogenesis in macromastic mammary glands. J Cell Mol Med 2014 July;18(7):1257-66. [DOI:10.1111/jcmm.12275]
6. Antoszewski B, Kasielska-Trojan A, Jones TE, Danilewicz M, Jones MW. The Immunohistochemical Profile of Mammary Tissue in Women With Macromastia and Its Potential Clinical Implications. Endocrinology 2024 Feb 20;165(4):bqae026. [DOI:10.1210/endocr/bqae026]
7. Perdikis G, Dillingham C, Boukovalas S, Ogunleye AA, Casambre F, Dal Cin A, et al. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty. Plast Reconstr Surg 2022 Mar;149(3):392e. [DOI:10.1097/PRS.0000000000008860]
8. Sigurdson L, Mykhalovskiy E, Kirkland SA, Pallen A. Symptoms and related severity experienced by women with breast hypertrophy. Plast Reconstr Surg 2007 Feb;119(2):481-6. [DOI:10.1097/01.prs.0000246407.87267.46]
9. Sabino Neto M, Demattê MF, Freire M, Garcia EB, Quaresma M, Ferreira LM. Self-esteem and functional capacity outcomes following reduction mammaplasty. Aesthet Surg J 2008;28(4):417-20. [DOI:10.1016/j.asj.2008.04.006]
10. Mello AA, Domingos NAM, Miyazaki MC. Improvement in quality of life and self-esteem after breast reduction surgery. Aesthetic Plast Surg 2010 Feb;34(1):59-64. [DOI:10.1007/s00266-009-9409-x]
11. Fonseca CC, Veiga DF, Garcia E da S, Cabral IV, de Carvalho MM, de Brito MJA, et al. Breast Hypertrophy, Reduction Mammaplasty, and Body Image. [cited 2025 Nov 18]; Available from: https://dx.doi.org/10.1093/asj/sjx271 [DOI:10.1093/asj/sjx271]
12. Dafydd H, Roehl KR, Phillips LG, Dancey A, Peart F, Shokrollahi K. Redefining gigantomastia. J Plast Reconstr Aesthet Surg 2011 Feb;64(2):160-3. [DOI:10.1016/j.bjps.2010.04.043]
13. Kalliainen LK, Committee AHP. ASPS Clinical Practice Guideline Summary on Reduction Mammaplasty. Plast Reconstr Surg 2012 Oct;130(4):785. [DOI:10.1097/PRS.0b013e318262f0c0]
14. American Society of Plastic Surgeons. 2024 Plastic Surgery Statistics Report [Internet]. [cited 2025 Nov 18]. Available from: https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf
15. Kerrigan CL, Collins DE, Striplin D, Kim MH, Wilkins E, Cunningham B, et al. The Health Burden of Breast Hypertrophy. Plast Reconstr Surg 2001 Nov;108(6):1591. [DOI:10.1097/00006534-200111000-00024]
16. Kerrigan CL, Collins ED, Kim HM, Schnur PL, Wilkins E, Cunningham B, et al. Reduction Mammaplasty: Defining Medical Necessity. Med Decis Making 2002 June 1;22(3):208-17. [DOI:10.1177/0272989X0202200309]
17. Becker H. Breast reduction insurance denials. Plast Reconstr Surg 2004 Nov;114(6):1687.
18. ASPS Recommended Insurance Coverage Criteria for Third-Party Payers | Reduction Mammaplasty.
19. Geiker NRW, Horn J, Astrup A. Preoperative weight loss program targeting women with overweight and hypertrophy of the breast - a pilot study. Clinical Obesity 2017;7(2):98-104. [DOI:10.1111/cob.12175]
20. Brown N, White J, Milligan A, Risius D, Ayres B, Hedger W, et al. The relationship between breast size and anthropometric characteristics. Am J Human Biol 2012;24(2):158-64. [DOI:10.1002/ajhb.22212]
21. Güemes A, Pérez E, Sousa R, Gil I, Valcarreres MP, Carrera P, et al. Quality of Life and Alleviation of Symptoms After Breast Reduction for Macromastia in Obese Patients: Is Surgery Worth It? Aesth Plast Surg 2016 Feb 1;40(1):62-70. [DOI:10.1007/s00266-015-0601-x]
22. Cunningham BL, Gear AJL, Kerrigan CL, Collins ED. Analysis of breast reduction complications derived from the BRAVO study. Plast Reconstr Surg 2005 May;115(6):1597-604. [DOI:10.1097/01.PRS.0000160695.33457.DB]
23. Setälä L, Papp A, Joukainen S, Martikainen R, Berg L, Mustonen P, et al. Obesity and complications in breast reduction surgery: are restrictions justified? J Plast Reconstr Aesthet Surg 2009 Feb;62(2):195-9. [DOI:10.1016/j.bjps.2007.10.043]
24. Zubowski R, Zins JE, Foray-Kaplon A, Yetman RJ, Lucas AR, Papay FA, et al. Relationship of obesity and specimen weight to complications in reduction mammaplasty. Plast Reconstr Surg 2000 Oct;106(5):998-1003. [DOI:10.1097/00006534-200010000-00006]
25. Olsen MA, Lefta M, Dietz JR, Brandt KE, Aft R, Matthews R, et al. Risk factors for surgical site infection after major breast operation. J Am Coll Surg 2008 Sept;207(3):326-35. [DOI:10.1016/j.jamcollsurg.2008.04.021]
26. ACS NSQIP Participant Use Data File [Internet]. ACS. [cited 2025 May 8]. Available from: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/participant-use-data-file/
27. Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 May 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541070/
28. Hendrix JM, Garmon EH. American Society of Anesthesiologists Physical Status Classification System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Nov 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441940/
29. Payton JI, Abraham JT, Novak MD, Monsivais SE, Hammonds KP, Altman AM. Impact of Age, Body Mass Index, and Resection Weight on Postoperative Complications in Reduction Mammaplasty. Plast Reconstr Surg 2023 Apr 1;151(4):727-35. [DOI:10.1097/PRS.0000000000009986]
30. Myung Y, Heo CY. Relationship Between Obesity and Surgical Complications After Reduction Mammaplasty: A Systematic Literature Review and Meta-Analysis. Aesthet Surg J 2017 Mar 1;37(3):308-15.
31. Ran R, Wang H, He X, Li J, Yu M, Mou E, et al. Risk factors for complications after reduction mammaplasty: a systematic review and meta-analysis. Eur J Med Res 2025 June 2;30(1):440. [DOI:10.1186/s40001-025-02723-z]
32. Liu D, Wu M, Xu X, Luo L, Feng J, Ou Y, et al. Risk Factors and Complications in Reduction Mammaplasty: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2023 Dec;47(6):2330-44. [DOI:10.1007/s00266-023-03387-y]
33. Goltsman D, Munabi NCO, Ascherman JA. The Association between Smoking and Plastic Surgery Outcomes in 40,465 Patients: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets. Plast Reconstr Surg 2017 Feb;139(2):503-11. [DOI:10.1097/PRS.0000000000002958]
34. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg 2017 June;70(6):734-40. [DOI:10.1016/j.bjps.2016.12.012]
35. Theocharidis V, Katsaros I, Sgouromallis E, Serifis N, Boikou V, Tasigiorgos S, et al. Current evidence on the role of smoking in plastic surgery elective procedures: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2018 May;71(5):624-36. [DOI:10.1016/j.bjps.2018.01.011]
36. Knoedler S, Jiang J, Schaschinger T, Kern B, Grundig H, Moog P, et al. Sugar-Coated Complications? The Impact of Diabetes on Outcomes of Breast Reduction. Aesthet Surg J 2025 Oct 7;sjaf201. [DOI:10.1093/asj/sjaf201]
37. Schaschinger T, Niederegger T, Brandt J, Knoedler S, Knoedler L, Matar DY, et al. Preoperative Hemoglobin A1C, Glycemic Status, and Postoperative Outcomes in General Surgery. JAMA Surg [Internet]. 2025 Nov 5 [cited 2025 Nov 21]; Available from: [DOI:10.1001/jamasurg.2025.4706]
38. Webster TK, Baltodano PA, Lu X, Zhao H, Elmer N, Massada KE, et al. Nationally Validated Scoring System to Predict Unplanned Reoperation and Readmission after Breast Reduction. Aesthetic Plast Surg 2022 Oct;46(5):2140-51. [DOI:10.1007/s00266-022-02966-9]
39. Knoedler S, Schaschinger T, Friedrich S, Schemet L, Matar DY, Niederegger T, et al. Beauty Under Pressure: The Impact of Hypertension on Outcomes in 54,000 Cases of Esthetic Breast Surgery. Aesthetic Plast Surg 2025 Aug 11; [DOI:10.1007/s00266-025-05089-z]
40. Stanek K, Nussbaum L, Labow BI, Chacko S, Ganske IM, Ganor O, et al. Understanding Hematoma Risk: Study of Patient and Perioperative Factors in a Large Cohort of Young Women Undergoing Reduction Mammaplasty. J Am Coll Surg 2024 May 1;238(5):900-10. [DOI:10.1097/XCS.0000000000000926]
41. Kim DK, Feuer GB, Warner PE, Ascherman JA. Predictors of extended length of stay following outpatient reduction mammaplasty. J Plast Reconstr Aesthet Surg 2024 July;94:141-9. [DOI:10.1016/j.bjps.2024.05.019]
42. Hotoleanu C. Association between obesity and venous thromboembolism. Med Pharm Rep 2020 Apr;93(2):162-8. [DOI:10.15386/mpr-1372]
43. Rahmani J, Haghighian Roudsari A, Bawadi H, Thompson J, Khalooei Fard R, Clark C, et al. Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants. Thrombosis Res 2020 Aug 1;192:64-72. [DOI:10.1016/j.thromres.2020.05.014]
44. Sigurdson LJ, Kirkland SA. Breast Volume Determination in Breast Hypertrophy: An Accurate Method Using Two Anthropomorphic Measurements. Plast Reconstr Surg 2006 Aug;118(2):313. [DOI:10.1097/01.prs.0000227627.75771.5c]
45. Collins ED, Kerrigan CL, Kim M, Lowery JC, Striplin DT, Cunningham B, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg 2002 Apr 15;109(5):1556-66. [DOI:10.1097/00006534-200204150-00011]
46. Simpson AM, Donato DP, Kwok AC, Agarwal JP. Predictors of complications following breast reduction surgery: A National Surgical Quality Improvement Program study of 16,812 cases. J Plast Reconstr Aesthet Surg 2019 Jan;72(1):43-51. [DOI:10.1016/j.bjps.2018.09.002]
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