Predictive risk factors of complications in reduction mammoplasty—analysis of three different pedicles

Abstract

Background: Reduction mammoplasty can be performed in several different techniques. Understanding the complication profile and risk factors in different reduction methods can help in choosing a technique, which serves the patient best. The authors present their experience of three different reduction techniques [superomedial pedicle (SMP), superior pedicle (SP) and inferior pedicle (IP)] with an emphasis on predictors of complications. Methods: A retrospective review of a prospectively maintained database of breast reductions between 2014 and 2020 was performed. Patient's demographics [age, body mass index (BMI), comorbidities, smoking, nipple to sternal notch distance (N-SN)], operative details (pedicle, tissue resected, drains, operating surgeon) and complications according to Clavien-Dindo classification were assessed. Study variables were compared against overall complication rates for the three techniques.Results: In total, 760 patients underwent reduction mammoplasty, including 578 (76%) bilateral and 182 (24%) unilateral operations. Of patients, 477 (63%) were operated with SMP, 201 (26%) with IP and 82 (11%) with SP. An average weight of resected tissue per breast was 460 g. Overall complication rate was 38%. The rate was higher in IP group (50%) compared to SMP (36%) and SP (22%) groups (P<0.001). Complications were mainly minor and related to delayed wound healing. The rate for major complications was 4%. Multivariable analysis showed that complications were associated independently with IP [odds ratio (OR) 1.89, 95% confidence interval (CI): 1.33-2.69], age <50 years (OR 1.87, 95% CI: 1.32-2.65), bilateral operation (OR 1.67, 95% CI: 1.00-2.76) and resected tissue weight ≥650 g per breast (OR 2.02, 95% CI: 1.36-2.99). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the presence of statistically significant risk factors (IP, age <50, bilateral operation and/or resected tissue ≥650 g per breast) increased (31%, 38%, 59% and 90% for number of 1, 2, 3 and 4 risk factors respectively, P<0.001). Conclusions:The rate of complication can be predicted by a risk-scoring system. In increasing variety of patients undergoing reduction mammoplasty, careful consideration of the best operation technique is important to prevent complications and costs.

Surgery for gigantomastia at the AKANDA Army Training Hospital: Analysis of 4 cases and literature review

“…This comorbidity factor could explain the delay. This delay is often observed in patients with risk factors, as described by Palvé 26 and Sachs 25 in their respective studies. Management of delayed skin closure consists of continuing local care with rigorous asepsis.…”

“…Bilateral gigantomastia was the most common in our study (75%), most often associated with a fibroadenoma. Gaye 24 and Palvé 26 report in their respective studies a predominance of bilateral gigantomastia. The mean breast axis in our study is similar to that reported by Abozeid, 27 in a case series study with 12-month follow-up of the Mac Kissock reduction plasty revisited, who found a similar result, i.e.…”

Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery

“…12 However, the superomedial pedicle represents only one approach in reduction mammaplasty and involves differences in technique, outcomes, and prevalence when compared with other approaches, such as inferior and superior pedicles. [13][14][15] These potential differences motivate a further exploration of the application of absorbable dermal staples during wound closure. In addition, in a review of the literature, we did not find a charge analysis of the impact of the absorbable deep dermal stapler that has incorporated overall hospital charge and operating room charges, which are important metrics for patients when considering financial burden.…”

“…A previous study provided evidence that absorbable dermal staple closures in breast reductions with superomedial pedicles were associated with equal improvements to quality of life and rate of postoperative complications when compared with dermal suture closures after reduction mammaplasty 12 . However, the superomedial pedicle represents only one approach in reduction mammaplasty and involves differences in technique, outcomes, and prevalence when compared with other approaches, such as inferior and superior pedicles 13–15 . These potential differences motivate a further exploration of the application of absorbable dermal staples during wound closure.…”

Risk factor stratification of three different pedicle techniques in reduction mammaplasty—the importance of an armamentarium of techniques individually addressing mild to severe breast hypertrophy

“…In the current study Palve et al present a retrospective review of 760 patients including three different pedicles [superomedial (SMP): 477 patients (63%); superior (SP): 201 patients (26%), and inferior (IP): 82 patients (11%) combined with statistical risk factor analysis to emphasize predictors of complications, classified by Clavien-Dindo ( 5 , 6 )]. A total of 578 patients (76%) were bilateral, 182 (24%) unilateral.…”