Breast reduction: safe in the morbidly obese?

With an increasing obese population, plastic surgeons are consulted by women requesting larger breast reductions, with body mass indices in the obese to morbidly obese range (30 to >or=40 kg/m) and breasts considered gigantomastic (>2000 g resected from each breast). There have been few descriptions of outcomes in the morbidly obese population. Previous literature reports high complication rates in obese women and large-volume breast reductions.

Retrospective investigation of 179 reduction mammaplasty patients was performed out to determine whether reduction mass, age, body mass index, smoking, method used (i.e., vertical pedicle, inferior pedicle/central mound, or free nipple graft), and comorbidities influenced complication rates. The patients were categorized by size of reduction, age, and body mass index.

The overall complication rate was 50 percent. There was no statistical difference in the incidence of complications attributable to size of reduction, age, or body mass index (p = 0.37, p = 0.13, and p = 0.38, respectively). Also, smoking status, method used (p = 0.65 and p = 0.17, and p = 0.48 and p = 0.1, respectively) and comorbidities had no effect on complication rates (reduction size, p = 0.054; age, p = 0.12; and body mass index, p = 0.072). There was no significant increase in the rate of complications for each body mass index group based on the reduction mass (p = 0.75, p = 0.89, p = 0.23, and p = 0.07).

It is as safe to perform large-volume breast reductions in the morbidly obese patient with comorbidities as in anyone else.