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Postoperative Outcomes After Breast Reduction: Do Racial Disparities Exist?
Samuel Knoedler1,2, Thomas Schaschinger3, Harriet Kiwanuka1
1Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Background:
Racial disparities in surgical outcomes are well documented across various procedures, including oncological and reconstructive breast surgery. However, it remains unclear whether these inequalities extend to reduction mammoplasty.
Methods:
We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database between 2011 and 2022 to identify adult female patients who underwent breast reduction and reported their racial identity. 30-day postoperative outcomes were compared across four racial groups-Asian, Black/African American, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander-against White patients using univariate and confounder-adjusted multivariate analyses.
Results:
The study cohort included 26,329 female patients, with 64% (n = 16,930) identified as White, 34% (n = 8,873) as Black/African American, 1.2% (n = 326) as Asian, 0.41% (n = 109) as American Indian/Alaska Native, and 0.35% (n = 91) as Native Hawaiian/Pacific Islander. A total of 1,660 adverse events (6.3%) occurred, with complication rates ranging from 4.0% (n = 13) in Asian patients to 6.5% (n = 1,108) in White patients. While breast reduction surgery was generally safe across all racial groups, multivariable analysis identified subtle yet statistically significant disparities: Black/African American patients had a significantly lower likelihood of overall (OR = 0.81) and surgical complications (OR = 0.65), including superficial incisional infections (OR = 0.50; all p < 0.001), but a higher risk of deep incisional infections (OR = 1.4; p = 0.013) and unplanned readmissions (OR = 1.3; p < 0.001). Asian patients demonstrated a significantly lower risk of surgical complications (OR = 0.23; p = 0.041).
Conclusion:
Breast reduction surgery is generally safe across all racial groups; however, our findings also unveiled subtle racial disparities in its postoperative outcomes. Black/African American patients were found to have a lower risk of overall and surgical complications but were more susceptible to deep incisional infections and unplanned readmissions. Asians were significantly less likely to experience surgical complications. These results reinforce the strong safety profile of reduction mammoplasty while underscoring the need for further research into the underlying factors contributing to differential outcomes.
