Clinical and aesthetic outcomes of secondary reduction mammaplasty
Amy Chen*, Asha D. Nanda, Shannon Garvey, Erin Kim, JacqueLyn Kinney, Natalie Pawlak, Daniela Lee, Monica Morgenstern, Bernard T. Lee, Ryan Cauley
Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Data on secondary reduction mammaplasty (SRM) outcomes and technical guidelines is scarce. This study seeks to assess clinical and aesthetic outcomes with respect to operative factors in SRM.
Reduction mammaplasties performed by 6 surgeons (2017-2021) at a single institution were included. SRM patients, defined by an additional reduction with a pedicled nipple-areolar-complex (NAC), were compared to random unmatched controls of primary mammaplasty (PRM) patients (1:3 cases to controls). Clinical data was extracted. Clinical photographs obtained 2-12 months postoperatively were graded by five blinded non-experts (research assistants) using the 13-item Validated Breast Aesthetic Scale. Univariate analyses were performed.
Of the 723 reduction mammaplasties identified, 3.7% were SRM. Among SRM cases, 26.0% had unknown prior pedicles. SRM patients trended toward lower resection volumes (p=0.0608) and were less likely to undergo inferior and superomedial pedicle reductions (p<0.0001). Wise incisions were used in nearly all SRM patients. Complications, readmission, revision, and scarring between groups were equivocal. Breast symmetry, breast shape and contour, inframammary fold, and NAC were rated significantly lower on aesthetic assessment of SRM breasts. On subset analysis of SRM cases, patients with unknown initial pedicles were more likely to undergo inferior pedicle reduction, vertical bipedicle reduction, or liposuction with skin resection. Patients with known initial pedicles were more likely than not to undergo SRM using the same pedicles. Based on these operative factors, complication rates, need for readmission or revision, incidence of hypertrophic/keloid scarring, and aesthetic ratings across all measures were equivocal between patients with known and unknown initial pedicles.
SRM patients had worse aesthetic outcomes on photographic analysis than PRM patients despite equivocal complication rates, demonstrating the consequence of non-satisfactory PRM. Importantly, we found that aesthetic SRMs can be safely achieved without knowledge of the initial pedicle.
Preoperative, operative, postoperative, and photographic analysis variables for reduction mammaplasty patients
| Primary vs Secondary Reduction Mammaplasty | Secondary Reduction Mammaplasty with Known vs Unknown Initial Pedicle | |||||
| Primary n = 90 | Secondary n = 27 | p | Known initial pedicle n = 20 | Unknown initial pedicle n = 7 | p | |
| Operative Factors | ||||||
| Volume removed (averaged from left and right breast) mean, SD | 579.1, 326.0 | 461.0, 265.1 | 0.0608 | 432.9, 264.9 | 541.2, 268.6 | 0.8166 |
| Pedicle n (%) | <0.0001 | |||||
| Inferior | 51 (56.7) | 12 (44.4) | 8 (40.0) | |||
| Superior | 18 (20.0) | 6 (22.2) | 3 (15.0) | |||
| Superomedial | 21 (23.3) | 2 (7.4) | 3 (15.0) | |||
| Central | 0 | 4 (14.8) | 3 (15.0) | |||
| Vertical bipedicle/liposuction with skin resection | 0 | 3 (11.1) | ||||
| Postoperative Factors n (%) | ||||||
| Any complication1 | 28 (31.1) | 8 (29.6) | 1.0000 | 5 (25.0) | 3 (42.9) | |
| Readmission | 4 (4.4) | 2 (7.4) | 0.6202 | 2 (10.0) | 0 | |
| Revision | 8 (8.9) | 4 (14.8) | 0.4685 | 4 (20.0) | 0 | |
| Hypertrophic or keloid scarring | 14 (15.6) | 2 (7.4) | 0.3556 | 1 (5.0) | 1 (14.3) | |
| Photographic Analysis mean, SD | ||||||
| Breast symmetry | 4.0, 0.6 | 3.5, 0.7 | 0.0317 | 3.9, 0.7 | 4.0, 0.6 | 0.1033 |
| NAC symmetry | 3.9, 0.5 | 3.7, 0.5 | 0.2593 | 3.8, 0.5 | 4.0, 0.5 | 0.1839 |
| Breast shape and contour | 3.7, 0.4 | 3.3, 0.7 | 0.0182 | 3.2, 0.7 | 3.4, 0.8 | 0.7280 |
| Inframammary fold | 4.5, 0.5 | 3.9, 0.6 | 0.0024 | 3.9, 0.6 | 4.0, 0.7 | 0.7135 |
| NAC position | 4.3, 0.5 | 3.9, 0.6 | 0.0241 | 3.9, 0.6 | 3.8, 0.8 | 0.7080 |
| NAC projection | 4.0, 0.7 | 3.4, 0.6 | 0.0042 | 3.5, 0.7 | 3.3, 0.5 | 0.5160 |
| NAC size | 4.3, 0.5 | 3.9, 0.6 | 0.0263 | 3.9, 0.7 | 3.8, 0.4 | 0.8170 |
| NAC shape | 4.3, 0.5 | 3.9, 0.6 | 0.8675 | 4.3, 0.5 | 4.4, 0.4 | 0.8533 |
| NAC color | 4.4, 0.5 | 3.7, 0.6 | 0.1654 | 4.6, 0.3 | 4.5, 0.5 | 0.8105 |
| Breast position | 4.1, 0.5 | 3.8, 0.6 | 0.0930 | 3.7, 0.6 | 4.1, 0.6 | 0.3278 |
| Breast Volume | 4.1, 0.5 | 3.7, 0.6 | 0.0179 | 3.8, 0.6 | 3.7, 0.7 | 0.8166 |
| Scar appearance | 4.0, 0.7 | 4.0, 0.9 | 0.9503 | 4.0, 0.8 | 3.8, 1.1 | 0.7366 |
1 Includes hematoma, seroma, infection, dehiscence, NAC hypopigmentation, NAC loss, and other complications. Abbreviations: n, frequency; %, column percentage; ?, greater than or equal to; NAC, nipple areolar complex; OR, operating room; SD, standard deviation.
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