Wound Dressing and Postoperative Complications Following Breast Reduction: A Retrospective Study of 250 Patients

Postoperative wound dressings are routine but understudied in reduction mammaplasty. Although an ideal dressing should promote healing, limit infection, and be well-tolerated, practice varies widely without consensus.

This study compares the impact of dressings on postoperative outcomes following reduction mammaplasty.

A single-institution, retrospective review was performed of reduction mammaplasty patients. Data included demographics, operative details, dressing type, and complications. Dressings included Dermabond (DER), Prineo (PRI), Histoacryl (HIS), Sylke (SYL), Steri-Strips (STE), and combinations (COM). Contralateral breasts in oncoplastic or free-flap cases were excluded.

A total of 250 patients (439 breasts) were included. At baseline, cohorts differed in BMI, American Society of Anesthesiologist class, diabetes, operative time, and resection weight (all P < .05), largely because of PRI, which contained higher-risk patients. Analyses were repeated, excluding PRI: differences resolved. On univariate analysis, PRI had the highest complication rates. Excluding PRI, HIS had higher skin reaction rates than SYL (P = .003) and COM (P = .049), and higher dehiscence than SYL (P = .043). On multivariate analysis, SYL predicted lower skin reaction (odds ratio [OR] 0.21, P = .003) and dehiscence (OR 0.47, P = .02). PRI predicted higher reoperation (OR 6.4, P = .01) and poor scarring (OR 34.8, P < .001), although limited by baseline confounding.

Dressing selection may affect wound outcomes after reduction mammaplasty. SYL tape was associated with lower rates of skin reaction and dehiscence across both analyses, although potentially limited by residual confounding. PRI's association with reoperation and poor scarring is notable but difficult to disentangle from patient selection bias. Combination dressings showed lower skin reaction rates but were heterogeneous, making interpretation challenging. Prospective data are needed to confirm these findings.

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