Impact of High Food Swamp Scores on Breast Reduction Outcomes: A Multivariate Analysis of 1052 Patients

"Food swamps" are areas with a high density of fast-food restaurants (unhealthy foods) relative to grocery stores (healthy foods). Patients in regions with inequitable access to healthy foods may have worsened surgical outcomes due to suboptimal nutrition. The present study assesses complication rates in breast reduction patients residing in regions with high food swamp scores (FSSs).

An institutional retrospective review of patients who underwent breast reduction surgery between 2015 and 2023 was conducted. The USDA Food Environment Atlas was accessed to identify New York county-level data. The Retail Food Environment Index was used to calculate all county FSSs and categorized as low, moderate, and high. Regression analysis assessed FSS as a predictor of complications.

A total of 1052 patients (1965 breasts) were identified and resided in low (22.1%), moderate (39.8%), or high (38%) FSS counties. Hispanic patients were predominant in high FSS counties (37.8%, P < 0.001). The overall complication rate was 11.3% (n = 119), with an increased rate in the high versus low FSS cohort (43.7% vs 14.3%, P = 0.039). Unplanned reoperations occurred in 31 patients (18.2%), more frequently in the high FSS cohort (4.3% vs 0.9%, P = 0.016). Regression analysis demonstrated a higher odds ratio (OR) for overall postoperative complications (OR, 1.9, P = 0.028), infections (OR, 1.34, P = 0.04) and unplanned reoperations (OR, 5.13, P = 0.03) among high FSS counties.

Environmental aspects of food swamps may increase complication risks following breast reduction. The present findings reinforce the need for further research on the interplay between food environmental factors and breast reduction outcomes.