Reduction Mammaplasty for Macromastia in Adolescents: A Systematic Review and Pooled Analysis

Hudson, Alexandra; Morzycki, Alexander; Guilfoyle, Regan

doi:10.1097/prs.0000000000008102

Cited by 14 publications

(13 citation statements)

References 39 publications

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“…The rate of revision surgery is small, and although patients may experience some postoperative breast growth, it is likely small and does not bring about a recurrence of symptoms. 16 Our analysis confirms this finding as we show obesity is not associated with reoperation rates in the short-term/immediate postoperative period (Table 2). Our analysis agrees with established literature that obesity is likely a risk factor for certain wound complications in reduction mammoplasty.…”

Section: Discussionsupporting

confidence: 87%

“…Although the overall rate of complication remains low (6.3%), increasing BMI portends increasing risk for superficial SSI. The rate of revision surgery is small, and although patients may experience some postoperative breast growth, it is likely small and does not bring about a recurrence of symptoms 16 . Our analysis confirms this finding as we show obesity is not associated with reoperation rates in the short-term/immediate postoperative period (Table 2).…”

Section: Discussionsupporting

confidence: 84%

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Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty

Stead,

Soliman,

Sobti

et al. 2024

Ann Plast Surg

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Introduction Pediatric reduction mammoplasty has become increasingly common due to the obesity epidemic. While obesity remains the leading cause of macromastia leading to surgery, it may also be a risk factor for postoperative complications. This study examines the safety of pediatric reduction mammoplasty and the risk of obesity for complications following this procedure. Methods The American College of Surgeons National Surgical Quality Improvement Program Pediatrics was queried to obtain all reduction mammoplasty cases from 2012 to 2020. Univariate and multivariate logistic regression analyses controlling for confounders were carried out to assess the relationship between body mass index (BMI) and rates of complication. Results One thousand five hundred eighty-nine patients with the primary Current Procedural Terminology code 19318 were included in the final analysis. The mean age was 16.6 (SD, 1.1) years, and the mean BMI was 30.5 (SD, 6.2) lb/in2. Notably, 49% of the patients were obese, and 31% were overweight, while only 0.4% were underweight. Forty-three patients (2.7%) sustained a superficial surgical site infection (SSI) postoperatively. Other complications were less prevalent, including deep SSI (4 patients, 0.3%), dehiscence (11, 0.7%), reoperation (21, 1%), and readmission (26, 1.6%). Independent variables analyzed included age, sex, BMI, diabetes mellitus, American Society of Anesthesiologists (ASA) class, and operative time, of which only BMI and ASA class were found to be significantly associated with SSI on univariate analysis. On multivariate logistic regression while controlling for ASA class and the false discovery rate, there was a strong association between increasing rates of superficial SSI and increasing BMI (unit odds ratio, 1.05; 95% confidence interval, [1.01, 1.09]; P = 0.02). The OR indicates that for each 1-unit increase in BMI, the odds of SSI increase by 5%. Conclusions Complications following pediatric reduction mammoplasty are uncommon, demonstrating the safety of this procedure. High BMI was found to have a significantly higher risk for superficial SSI. Increased caution and infection prophylaxis should be taken when performing this operation on obese patients.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 84%

Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty

Stead,

Soliman,

Sobti

et al. 2024

Ann Plast Surg

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“…5,12,13 For adolescents who underwent reduction mammaplasty irrespective of oncoplastic techniques, patients have reported long-term complications. In a study by Hudson et al, 28 21.7% of patients reported having altered nipple sensation. Nuzzi et al 5 found 8.9% of patients having partial hypesthesia of the nipple-areola or breast, and Patel and Corcoran 29 observed 7.8% of patients having partial breast hypesthesia beyond 1 year.…”

Section: Discussionmentioning

confidence: 91%

“…Nuzzi et al 5 found 8.9% of patients having partial hypesthesia of the nipple-areola or breast, and Patel and Corcoran 29 observed 7.8% of patients having partial breast hypesthesia beyond 1 year. These studies by Hudson et al, 28 Nuzzi et al, 5 and Patel and Corcoran 29 did not use oncoplastic techniques, but their implications for long-term outcomes for pediatric patients are relevant. Kraut et al 12 reviewed breastfeeding outcomes of patients with a history of breast reduction surgery and found that the median breastfeeding success was dependent on the subareolar parenchyma preserved: 4% (interquartile range [IQR], 0%–38%) for techniques with no preservation, 75% (IQR, 37%–100%) for techniques with partial preservation, and 100% (IQR, 75%–100%) for techniques with complete preservation.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors

et al. 2023

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Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.

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“… 11–16 We also had revision rates comparable to or lower than those reported in the literature for thigh lifts (13.6%), 17 mastopexies (12.6%), 18 , 19 abdominoplasties (8.8%), 20 , 21 blepharoplasties (8.5%), 22 facelifts (6.5%), 23 and breast reduction (4.8%). 24 , 25 Despite offering revisions at no cost, eliminating this cost barrier does not appear to manifest a notable increase in the number of revisions provided to patients. Thus, in the context of surgical literature, our revision rates suggest that a no-cost revision policy may not result in a substantial increase in revision surgeries and offer the added benefit of providing reassurance to prospective patients.…”

Section: Discussionmentioning

confidence: 99%

Offering No-Cost Cosmetic Revisions: The Experience of an Academic Cosmetic Surgery Program

Moura

Wirth

Shaffrey

et al. 2023

Aesthetic Surgery Journal Open Forum

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Background The financial principles of a no cost revision policy and their implications for revision rates are not well understood. Objectives Therefore, the primary objective of this retrospective study is to report our no cost revision rates and, secondarily, to survey the cosmetic revision policies of other cosmetic surgery practices and detail the financial principles underpinning no cost revisions. Methods All aesthetic surgeries and no cost revisions performed by the plastic surgeons, oculoplastic surgeons, and facial plastic and reconstructive surgeons at our academic outpatient cosmetic surgery center from January 1, 2016 to June 30, 2022 were identified using procedural codes. Data on number of surgeries, number of revisions, operative minutes, and time intervals between initial and revision surgeries were collected. A survey was administered to assess the revision policies of similar cosmetic surgery practices. Results A total of 1491 aesthetic surgeries and minimally invasive procedures were included, and 125 revision procedures were performed (8.4%). Thigh lifts (3, 13.6%), rhinoplasties or septoplasties (25, 15.8%), and otoplasties (3, 27.3%) had the highest revision rates. Three practices (15%) offered cosmetic revisions at no cost, 9 (45%) did not apply a surgeon’s fee, 5 (25%) evaluated fees on a case-by-case basis, 1 (5%) offered revisions with an insurance policy, and 2 (10%) cosmetic surgery practices did not offer revisions at a reduced rate. Conclusions Despite offering revisions at no cost, our revision rates are reasonable for an academic cosmetic surgery practice. The revision policies offered to patients on the private market are varied, but most surveyed practices offer revisions at either a reduced rate or no cost.

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Reduction Mammaplasty for Macromastia in Adolescents: A Systematic Review and Pooled Analysis

Cited by 14 publications

References 39 publications

Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty

Obesity Portends Increasing Rates of Superficial Surgical Site Infection Following Pediatric Reduction Mammoplasty

Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors

Offering No-Cost Cosmetic Revisions: The Experience of an Academic Cosmetic Surgery Program

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