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Effect of obesity on complications in short scar breast reduction: A retrospective study of 236 patients
Eleanor Goldwasser, MD, Ava G. Chappell, BA, Nathaniel Erskine, BS, Mustafa Akyurek, MD, PHD.
UMass Medical School, Worcester, MA, USA.

BACKGROUND
Prior studies have examined the relationship between obesity and adverse outcomes after reduction mammaplasty, suggesting a correlation between increasing body mass index (BMI) and postoperative complications. However, there is little data published regarding such correlation with respect to short scar technique. Therefore, we present an investigation of the role of BMI in predicting adverse outcomes following short scar breast reduction.
METHODS
A total of 236 patients underwent short scar mammaplasty with a superiomedial pedicle from 2008-2014. The procedure was performed by a single surgeon at an academic medical center. Data was obtained retrospectively from medical records, documenting patient characteristics and adverse outcomes. Adverse outcomes included: delayed healing, major wounds, nipple necrosis, fat necrosis, seroma, hematoma, infection, revision, and dog-ear deformities. BMI was calculated from height and weight measurements at the time of the procedure, and categorized according to standard NIH cutoffs of normal (18-24.9), overweight (25-29.9), obese class I (30-34.9), obese class II (35-39.9) and obese class III (40 and above). Univariate and multivariate logistic regression analysis was used to calculate crude and adjusted odds ratios (ORs) for the association of BMI category and the development of any adverse outcome.
RESULTS
Patients were grouped by the following BMI categories: <25 (N=27), 25 to <30 (N=71), 30 to <35 (N=73), 35 to <40 (N=45), and >40 kg/m2 (N=20). The mean follow up period was 260 days. The total complication rate in each group was 22.2%, 23.9%, 27.4%, 33.3%, and 45.0% respectively (Table I). Although the proportion of patients experiencing at least one adverse outcome increased across the ascending BMI categories (p trend= 0.145), there was no statistically significant difference between the groups. Both crude analysis and analysis with adjustment for age, smoking, total weight removed, history of hypertension and diabetes mellitus did not show a significant relationship between increasing BMI category and the development of an adverse outcome (Table II).
CONCLUSION
This study of 236 patients who underwent short scar reduction mammaplasty found a positive trend in the incidence of adverse outcomes as BMI increased. However, this was not statistically significant. Further study with larger sample sizes for each BMI category is warranted to determine if higher BMI is a significant risk factor for complications following short scar mammaplasty.
Table I: Adverse Outcomes by BMI Category
n=27n=71n=73n=45n=20
Adverse OutcomeBMI 18.5-24.9BMI 25-29.9BMI 30-34.9BMI 35-39.9BMI>40P-value
Delayed healing/wound1 (3.7%)6 (8.5%)10 (13.7%)8 (17.8%)2 (10.0%)0.35
Fat necrosis0 (0.0%)5 (7.0%)7 (9.6%)2 (4.4%)4 (20.0%)0.10
Infection1 (3.7%)2 (2.8%)2 (2.7%)4 (8.9%)3 (15.0%)0.13
Hematoma3 (11.1%)1 (1.4%)2 (2.7%)1 (2.2%)1 (5.0%)0.18
Seroma1 (3.7%)0 (0.0%)2 (2.7%)1 (2.2%)1 (5.0%)0.59
Nipple necrosis0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)NA
Revision of dog ears2 (7.4%)7 (9.9%)7 (9.6%)3 (6.7%)1 (5.0%)0.93
Total complication rate6 (22.2%)17 (23.9%)20 (27.4%)15 (33.3%)9 (45.0%)0.34

Table II: Patient Characteristics by BMI Category
Patient characteristicsBMI 18.5-24.9BMI 25-29.9BMI 30-34.9BMI 35-39.9BMI>40
Age (years)38.338.938.436.042.5
BMI (Kg/m2)23.027.632.637.444.4
Diabetes1 (3.7%)0 (0/0%)3 (4/1%)1 (2.2%)2 (10.0%)
Hypertension0 (0.0%)10 (14.1%)11 (15.1%)10 (22.2%)5 (25.0)
Smoking5 (18.5%)15 (21.1%)21 (28.8%)11 (24.4%)7 (35.0%)
Mean total reduction + liposuction (g)525.6680.5815.71105.21179.7


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