Reduction Mammoplasty: A Comparison Between Operations Performed by Plastic Surgery and General Surgery

Area of Science:

• Plastic Surgery
• General Surgery
• Surgical Outcomes

Background:

• Reduction mammoplasty is a common procedure performed by both plastic and general surgeons.
• Debate exists regarding whether this procedure should remain exclusive to surgical specialists.
• The National Surgical Quality Improvement Project (NSQIP) offers data to compare outcomes between specialties.

Purpose of the Study:

• To compare preoperative comorbidities and 30-day postoperative complications of reduction mammoplasty performed by general surgery versus plastic surgery.
• To evaluate the impact of surgical specialty on patient outcomes in reduction mammoplasty.

Main Methods:

• Utilized the NSQIP database from 2005-2012, identifying reduction mammoplasties (CPT codes) in female patients with breast hypertrophy (ICD-9 code 611.1).
• Collected data on patient demographics, preoperative variables, and specific postoperative outcomes including infections, dehiscence, pulmonary complications, and reoperation.
• Compared outcomes between procedures performed by general surgery and plastic surgery specialists.

Main Results:

• A total of 6,239 reduction mammoplasties were analyzed: 339 by general surgery and 5,900 by plastic surgery.
• No significant differences were found in superficial or deep surgical site infections, organ space infections, or wound dehiscence between the groups.
• General surgery patients experienced a higher likelihood of skin flap failure requiring reoperation (P < .05) and had longer operative times (P < .05).

Conclusions:

• While overall complication rates were similar, specific adverse events like skin flap failure were more frequent in reduction mammoplasties performed by general surgeons.
• These findings suggest that focused training in reduction mammoplasty, as typically received by plastic surgeons, may offer patient benefits.
• Limitations include the absence of long-term data on aesthetic outcomes, nipple sensation, and late wound complications.