Understanding Hematoma Risk: Study of Patient and Perioperative Factors in a Large Cohort of Young Women Undergoing Reduction Mammaplasty

Abstract

Background: Despite high satisfaction rates, reduction mammaplasty can have complications such as hematoma. Factors like age, tobacco use, and comorbidities are known contributors, while the influence of race, BMI, certain medications, and blood pressure (bp) remain contentious. This study investigates hematoma risk factors in young women undergoing reduction mammaplasty. Study Design: A retrospective review was conducted including all female patients who underwent bilateral reduction mammaplasty at a single institution between 2012 and 2022. Data on demographics, BMI, medical comorbidities, surgical techniques, medications, and perioperative bp were collected. Differences between patients who developed a hematoma and those who did not were assessed using chi-square, Fisher’s exact, and t-tests. The relationship between perioperative bp and hematoma formation was assessed using logistic regression. Results: Out of 1754 consecutive patients, 3.0% developed postoperative hematoma of any kind, with 1.8% returning to the operating room. Age (OR=1.14, p=0.01) and ketorolac use (OR=3.93, p=0.01) were associated with hematoma development. Controlling for baseline bp, each 10mm Hg incremental increase in peak intraoperative bp (systolic: OR=1.24, p=0.03; MAP: OR=1.24, p=0.01) and postoperative bp (systolic: OR=1.41, p=0.01; MAP: OR=1.49, p=0.01) escalated the odds of hematoma. Postoperative systolic bp variability also incrementally increased hematoma odds (OR=1.48, p<0.01). Other factors, including race and surgical technique, were not significantly influential. Conclusions: Age, ketorolac use, and intra- and post-operative bp peaks and variability are risk factors for hematoma in reduction mammaplasty. This emphasizes the importance of perioperative bp management and optimizing pain management protocols.