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BACKGROUND:Reduction mammoplasty is an often-performed procedure by plastic surgeons and increasingly by general surgeons. The question has been posed in both general surgical and plastic surgical literature as to whether this procedure should remain the domain of surgical specialists. Some general surgeons are trained in breast reductions, while all plastic surgeons receive training in this procedure. The National Surgical Quality Improvement Project (NSQIP) provides a unique opportunity to compare the 2 surgical specialties in an unbiased manner in terms of preoperative comorbidities and 30-day postoperative complications.
METHODS: The NSQIP database was queried for the years 2005 - 2012. Patients were identified as having undergone a reduction mammoplasty by Current Procedural Terminology codes. Results were refined to include only females with an International Classification of Disease, revision 9 code of 611.1 (Hypertrophy of breasts). Information was collected regarding age, surgical specialty performing procedure, body mass index (BMI), and other preoperative variables. The outcomes utilized were presence of superficial surgical site infection (SSI), presence of deep SSI, presence of wound dehiscence, postoperative respiratory compromise, pulmonary embolism, deep vein thrombosis (DVT), peri-operative transfusion, operative time, reintubation, reoperation and length of hospital stay.
RESULTS: During this time period there were 6239 reduction mammaplasties performed within the NSQIP database, 339 by General Surgery and 5900 by Plastic Surgery. No statistical differences were detected between the two groups with regards to superficial wound infections, deep wound infections, organ space infections, or wound dehiscence. There were no significant differences noted between with groups with regard to systemic postoperative complications. Patients undergoing a procedure by general surgery were more likely to experience a failure of skin flaps necessitating a return to the operative room (p < 0.05). Operative time was longer in procedures performed by general surgery (p < 0.05).
CONCLUSIONS: Several important differences appear to exist between reduction mammaplasties performed by General Surgery and Plastic Surgery. Increased operative time places the patient at greater risk for blood loss and anesthesia-related complications. An increased rate of return to the operating room implies an increased rate of postoperative complications. A focused training in reduction mammoplasty appears to be beneficial to the patient. The limitations of this study include a lack of long-term follow up with regard to aesthetic outcome, nipple malposition, nipple sensation, and late wound sequelae.