Risk factors and complications in reduction mammaplasty: novel associations and preoperative assessment

Although risk factors for complications following reduction mammaplasty are well known, it is difficult to assess risk for specific complications among patients with multiple factors or varying gradations of a single factor. The purpose of this study was to identify all associations between patient characteristics and specific complications and to quantify the risk attributable to these factors, to assess a prospective patient's individualized risk.

Patient characteristics and complications were identified through retrospective chart review of a consecutive series of patients who underwent Wise-pattern, inferior-pedicle reduction mammaplasty performed by the senior author (C.L.P.) over the past 10 years. Chi-square, t test, logistic regression, and decision tree analyses were used to identify complications attributable to specific risk factors and, when possible, to quantify the risk imparted by those factors.

The charts of 485 patients were reviewed. Factors predictive of nonspecific complications included hypertension, fibromyalgia, previous breast surgery, and fibroproliferative breast abnormality. Factors predictive of specific complications included body mass index, associated with wound-healing complications; mass of resection, associated with wound-healing complications and decreased nipple sensitivity and inversely related to hypertrophic scarring; and intraoperative hypotension, associated with hematoma.

Based on the review of a large series of reduction mammaplasties, specific and quantifiable patient characteristics were linked to specific and quantifiable complications. Novel associations were drawn, including increased risk of hematoma with intraoperative hypotension and decreased risk of hypertrophic scarring with mass of resection. A "risk assessor" was constructed that estimates a prospective patient's individualized risk based on selected preoperatively identifiable characteristics, facilitating patient selection and preoperative counseling.