For patients undergoing breast reduction surgery (reduction mammaplasty), higher body mass index (BMI) is a risk factor for delayed wound healing, reports a study in the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
“While reduction mammaplasty is a safe procedure, our study suggests that patients in higher BMI categories may take longer to heal, with increased risk of wound healing times longer than two months,” says lead author Jesse Payton, MD, a plastic surgeon at Baylor Scott & White Medical Center, Temple, Texas. Older age is also identified as a risk factor for minor complications.
Age and Weight Impact Breast Reduction Complication Risk
Reduction mammaplasty is the standard of care for reducing physical symptoms (such as back and neck pain) and improving psychological well-being (such as poor body image and low self-esteem) in women with overlarge breasts (macromastia). Some previous studies have suggested that patients with higher BMI—a standard measure of body weight per height – are at higher risk of complications after breast reduction surgery. That’s an important consideration, as many patients with high BMI have macromastia-related symptoms.
To assess BMI and other possible risk factors for complications, Payton and colleagues reviewed their department’s experience with 277 patients undergoing reduction mammaplasty between 2014 and 2018. Average age was 36 years and average BMI 30 kilograms per square meter (kg/m2). Although most were at or above this high-BMI cutoff point, the patients were generally healthy, with low rates of other health problems.
Nearly half of patients experienced minor complications: a rate of 49.1%. The most common category of minor complications was superficial wound-healing problems, occurring in 42.1% of patients. Major complications were uncommon, occurring in 4.31% of patients. On initial analysis, BMI was unrelated to the risk of minor or major complications.
However, patients in higher BMI categories were more likely to have delayed wound healing, with healing times longer than two months. Higher-BMI patients also had longer surgical times and greater amounts of tissue removed at surgery (resection weights). Older age was also associated with an increased rate of minor complications.
Delayed Wound Healing Increases at Highest BMI Levels
After adjustment for age and resection rate, high BMI remained a significant risk factor for wounds requiring longer than two months to heal. For every 5 kg/m2 increase in BMI, the estimated odds of delayed wound healing increased by 77%. High BMI was not related to the overall risk of minor or major complications, although there was a “positive trend“ in that direction.
Older age was an independent risk factor for minor complications in the adjusted analysis. For each decade of age, the estimated odds of minor complications increased by 22%.
The study adds to previous evidence that BMI is a risk factor for complications after reduction mammaplasty and is first to focus on wound healing times of longer than two months. The authors suggest that patients should be counseled about the BMI- and age-related increase in risks. For those in the highest BMI categories, steps to optimize patients’ health before surgery might help to reduce complication risks.
“Women with higher BMI are more likely to require larger resections, longer operative times and are at higher risk for wound healing requiring greater than two months,” Payton and coauthors conclude. They add: “While BMI is an important consideration for determining operative candidacy, the benefits of reduction may outweigh these risks in carefully selected patients.”