Factors associated with complications in vertical breast reduction mammaplasty in the pediatric population.
Monica Manrique*, Ashley E. Rogers, Haley Oh, Nakul Ganju, Esperanza Mantilla-Rivas, Md Sohel Rana, Albert Oh, Gary F. Rogers
Plastic and Reconstructive Surgery, Children's National Hospital, Washington,
Vertical breast reduction (VBR) involves making a keyhole pattern made with an incision around the areola and vertically down the breast. Used to manage breast hypertrophy, there is a paucity of the literature regarding outcomes associated to VBR in adolescents with gigantomastia [>1000 grams (gr) of breast tissue excised]. We aim to evaluate the prevalence of postoperative complications after VBR in the pediatric population, and analyze factors that may be associated with higher complication risk in these patients
After IRB approval, we retrospectively reviewed patients under 19 years of age who underwent VBR at our institution between 2012 to 2022. Demographics, symptoms during first evaluation, body mass index (BMI), amount of breast tissue excised, postoperative complications and persistence of symptoms after surgery, were recorded. Postoperative outcomes were compared among the BMI status (Healthy weight BMI<25; overweight BMI 25-30; obesity BMI>30), the amount of breast tissue excised (1000gr vs >1000gr), and time of follow-up
Forty-one patients met inclusion criteria. Mean age at first evaluation was 16.9 years. The majority of patients were African American (68.3%), obese (56.1%), and had ptosis grade 3 (82.9%). Most prevalent symptoms included back pain, and exercise difficulties. Mean nipple to sternal notch was 31.9 cm.
Mean age at surgery was 17.3 years, and of breast tissue excised was 1119.9 grams.
At a mean of 4.9 months after surgery, 7 patients (19.44%) presented complications including bleeding, hematoma, and wound dehiscence. Furthermore, 6 patients showed persistence of initial symptoms including back, neck or shoulder pain, and breast asymmetry.
Patients with >1000 gr of breast tissue excised had higher rate of complications (37.5% vs. 5.0%, p=0.014). Among BMI groups, complication rate was not statistically significant.
Although useful for adolescents with gigantomastia, vertical reduction mammaplasty technique can cause complications, which can be significantly higher among patients who had excision of over 1000 grams of breast tissue.
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