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Impact of Autoimmune Connective Tissue Diseases on Breast Reduction Complication Rates
Keisha Montalmant
*, Ivory Fu, Olachi Oleru, Nargiz Seyidova, peter shamamian, Daniel Y. Kwon, Esther Kim, Simeret Genet, Abena Gyasi, Peter W. Henderson
Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Nesconset, NY
Background: Autoimmune diseases (AD) can destroy native tissues due to immune system dysregulation and loss of physiological tolerance to "self-antigen", which increases the risk for postoperative complications. Data related to breast reduction (BR) outcomes in AD patients, however, is limited. Therefore, the present study aims to quantify the risk of complications in this group.
Methods: An institutional retrospective review of patients who underwent BR surgery between 2017 and 2023 was conducted. Autoimmune diseases were categorized as connective tissue disease (CTD) (systemic lupus erythematosus, rheumatoid arthritis, Sjogren's disease, and polymyalgia rheumatica) and non-connective tissue disease (non-CTD) (multiple sclerosis, Grave's disease, Hashimoto's thyroiditis, Crohn's disease, and celiac disease). Demographics, comorbidities, operative techniques, and complications were collected.
Results: A total of 72 patients (126 breasts) with non-CTD (58.8%) or CTD (41%) were identified. The mean age was 47.9 ±15.3 years. Fifty-four patients (75%) underwent bilateral BR, and eighteen (25%) underwent unilateral BR. The superomedial pedicle (45.8%) and inferior pedicle technique (44.4%) were primarily used. The complication rate for all BR procedures in the database was 15%. Complications occurred in 26% of CTD patients: fat necrosis (13.3%), infection (13.3%), seroma (10%), T-junction breakdown (6.6%), and wound dehiscence (3.3%). One non-CTD patient required revision. The average intraoperative blood loss was 70 ± 76.8 mL in CTD patients and 61.8 ± 62.1 mL in non-CTD patients. The mean length of operation was 3.04 ± 1.17 hours in CTD patients and 2.6 ± 1.29 hours in non-CTD patients.
Conclusions: Autoimmune CTD patients had a relatively high rate of postoperative complications with increased intraoperative blood loss and operative time. These findings suggest that CTD patients may have a greater risk of complications and highlight the importance of careful patient selection, preoperative risk stratification, and tailored postoperative care in AD patients.
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