Page 270 - Read Online

determined to affect wound complications after breast reduction without increased detriment on other
major complications when compared to the non-obese. Obesity should be a considered with other
preoperative comorbidities, rather than an independent contraindication to surgery. Breast reduction
appears to be safe in the obese patient who is otherwise healthy.
Key words:

Obesity; breast reduction; reduction mammoplasty; National Surgical Quality Improvement
Program; propensity score

INTRODUCTION on multivariable analysis. However, no study to date has
harvested the statistical power of the NSQIP dataset with
Breast reduction surgery, or reduction mammaplasty, the use of propensity score matching to evaluate the
is a commonly performed procedure for the treatment effect of obesity as an independent risk factor on breast
of symptomatic macromastia. Over 101,000 breast reduction outcomes. Multivariable analysis attempts
reductions were performed in 2014. Patients seek relief to control for heterogeneity between patient cohorts
[1]
from back and neck pain, intertriginous rashes, shoulder via advanced statistical techniques. Patient matching,
grooving, ill-fitting clothing, and dissatisfaction with however, eliminates heterogeneity between patient
breast appearance. Breast reduction has been shown to cohorts by 1:1 matching each experimental group patient
improve physical, psychosocial, and sexual well-being. with a control group patient with similar characteristics.
[2]
Patients experience enhanced quality of life and are The goal of this study is to isolate the effect of obesity on
[3]
highly satisfied with the procedure. [4,5] breast reduction outcomes using 1:1 patient matching.
The incidence of postoperative complications in reduction METHODS
mammaplasty is relatively low, approximately 6%.
[6]
Problems range from minor wound complications and Data acquisition
infections to significant bleeding and thromboembolic Patients undergoing primary reduction mammaplasty
events. Thorough preoperative assessment is imperative were identified from the 2005-2013 ACS-NSQIP registry.
to patient safety and avoiding poor surgical outcomes.
Methods for data acquisition involved trained research
nurses from participating institutions in the United
Many women suffering from symptomatic macromastia States who collected data through systemic sampling of
are obese. Given the increasing number of obese patients surgical procedures, as previously described. A total
[18]
in the general population, the role of body mass index
(BMI) as a preoperative assessment factor remains of of 240 variables were collected for each case. Further
great interest to the surgical community. Obese patients information can be accessed via the ACS-NSQIP website
are more likely to have medical comorbidities, including at http://www.acsnsqip.org/. Data are depersonalized
hypertension, diabetes, chronic respiratory disease and Health Insurance Portability and Accountability Act
and obstructive sleep apnea. They are 35% more likely compliant.
to have an emergency department visit or hospital
[7]
admission 30 days after outpatient surgery. Many The NSQIP registry was queried using Current
surgeons require obese patients to lose weight prior to Procedural Terminology code 19318 to identify patients
undergoing surgery, and certain insurance carriers use who had undergone reduction mammaplasty. Patients
higher weights as refusal criteria for coverage. The were then characterized according to the World Health
[8]
role of obesity in postoperative complications following Organization (WHO) classification of obesity: non-obese
2
2
reduction mammaplasty is inconsistently defined in the (BMI < 30 kg/m ), class I obesity (BMI 30-34.9 kg/m ),
2
literature. Some studies associate obesity with increased class II obesity (BMI 35-39.9 kg/m ), or class III (BMI ≥
2
postoperative complications, [9-13] whereas others find no 40 kg/m ). Inclusion criteria included primary bilateral
statistically significant correlation. [14-17] breast reductions.
In 2014, Nelson et al. studied obesity and reduction Outcome variables
[6]
mammaplasty using the 2005-2011 American College of Primary outcomes of interest were analyzed through
Surgeons - National Surgical Quality Improvement Program several pre-defined NSQIP variables, including patient
(ACS-NSQIP) datasets. NSQIP is a nationally-validated, demographics and comorbidities, as well as early surgical
risk-adjusted surgical outcomes database to measure complications, defined as adverse events occurring within
and improve the quality of surgical care. The authors 30 days after surgery. Demographics included race and
reported an increased rate of overall complications in the age. Comorbidities included diabetes (further classified
early 30-day postoperative period among obese patients into insulin dependent and non-insulin dependent),
260 Plast Aesthet Res || Volume 3 || July 28, 2016