Obesity in mammaplasty: a study of complications following breast reduction

Access to effective surgical treatments such as breast reduction is often restricted on the grounds of patient obesity. However, there is a lack of unambiguous data on the surgical risks of obesity in patients undergoing breast reduction. The aim of this study was to assess the relationship between patient obesity, as determined by body mass index (BMI), and surgical outcome following bilateral breast reduction (BBR).

Retrospective review of case notes was conducted for 306 patients who underwent BBR in our unit over a 5-year period. BMI, resection weight, smoking history, technique, complications and outcomes were determined from records of follow-up assessment.

Overall complication rate was 53.9%, with multiple complications of 22.9%. A significant increase in complications after BBR with increasing BMI was identified (p = 0.019 any complication, p = 0.002 multiple complications). The effect of BMI on multiple complications was significant and independent of resection weight (p = 0.031) and reduction technique (p = 0.020). Smoking was associated with higher wound dehiscence and multiple complications. We developed a model for predicting risk of complications based on key variables. Despite higher complications, there was no significant difference in aesthetic outcome at follow-up between the BMI groups.

These findings add to the body of evidence that obesity is associated with an increased risk of post-operative complications. This has implications for surgeons and healthcare payers. However the majority of complications were minor and aesthetic outcomes were satisfactory in the majority of cases. The use of a 'target' BMI as exclusion criteria should therefore be treated with caution.