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[4]
            experienced postoperative  soft  tissue  necrosis.  The   news-resources/statistics/2014-statistics/plastic-surgery-statsitics-full-
            pathophysiology of wound healing in obese patients    report.pdf. [Last Accessed on January 6, 2016].
            is currently being studied. Obesity  has been shown to   2.   Coriddi M, Nadeau M, Taghizadeh M, Taylor A. Analysis of satisfaction
                                                                  and well-being following breast reduction using a validated survey
            inhibit  bone  marrow-derived vasculogenic progenitor   instrument: the BREAST-Q. Plast Reconstr Surg 2013;132:285-90.
            cell mobilization, trafficking and function. This in turn   3.   Blomqvist L, Brandberg Y. Three-year follow-up on clinical symptoms
            impairs  the  normal response to tissue  injury  and the   and  health-related  quality  of  life  after  reduction  mammaplasty.  Plast
                                      [25]
            proliferation of blood  vessels.  Adipocytes in fat also   Reconstr Surg 2004;114:49-54.
            produce macrophage migration inhibitory factor, a factor   4.   Carty MJ, Duclos A, Gu X, Elele N, Orgill D. Patient satisfaction and
                                                                  surgeon  experience:  A  follow-up  to  the  reduction  mammaplasty
            which decreases wound healing through impairment of   learning curve study. Eplasty 2012;12:e22.
            macrophage polarization/activation and inhibition  of   5.   Davis GM, Ringler SL, Short K, Sherrick D, Bengtson BP. Reduction
            adipocyte progenitor cells. [26]                      mammaplasty:  long-term  efficacy,  morbidity,  and  patient  satisfaction.
                                                                  Plast Reconstr Surg 1995;96:1106-10.
                                                              6.   Nelson JA, Fischer JP, Chung CU, West A, Tuggle CT, Serletti JM, Kovach
            Like other NSQIP-based analyses  of reduction         SJ. Obesity and early complications following reduction mammaplasty:
            mammaplasty,  there  are  limitations  to this  study. [6,27]    an analysis of 4545 patients from the 2005-2011 NSQIP datasets. J
            Follow-up was only 30  days, a relatively short period   Plast Surg Hand Surg 2014;48:334-9.
            of time.  NSQIP  does not include complications such   7.   Sieffert M, Fox JP, Abbott LE, Johnson RM. Obesity is associated with
            as seroma, hematoma,  fat necrosis,  altered nipple   increased health care charges in patients undergoing outpatient plastic
                                                                  surgery. Plast Reconstr Surg 2015;135:1396-404.
            sensation, aesthetic outcomes, or hypertrophic scarring.   8.   Nguyen JT, Wheatley MJ, Schnur PL, Nguyen TA, Winn SR. Reduction
            Setala et al.  report complication rates amongst normal   mammaplasty: a review of managed care medical policy coverage
                      [15]
            BMI,  overweight,  and obese,  respectively,  as  follows:   criteria. Plast Reconstr Surg 2008;121:1092-100.
            seroma, 8.6% vs. 10.0% vs. 3.0%; hematoma, 8.6% vs. 5.4%   9.   Zubowski  R,  Zins  JE,  Foray-Kaplon A, Yetman  RJ,  Lucas AR,  Papay
            vs. 3.0%; and fat necrosis, 1.7% vs. 2.0% vs. 6.1%. These   FA, Heil D, Hutton D. Relationship of obesity and specimen weight
                                                                  to complications in reduction mammaplasty.  Plast Reconstr Surg
            are significant complications for this operation, which   2000;106:998-1003.
            vary amongst different BMI classes and may explain a   10.  Blomqvist  L.  Reduction  mammaplasty:  analysis  of  patients’  weight,
            lower overall complication rate in  our analysis.  These   resection weights, and late complications. Scand J Plast Reconstr Surg
                                                                  Hand Surg 2006;30:207-10.
            datasets also do not report pedicle design/skin incision   11.  Gamboa-Bobadilla GM, Killingsworth C. Large-volume reduction
            or resection weights, which may also affect complication   mammaplasty:  the  effect  of  body  mass  index  on  postoperative
            rates.  Although NSQIP  provides a powerful dataset,   complications. Ann Plast Surg 2007;58:246-9.
                 [9]
            further investigation is warranted  through prospective   12.  Baldwin CJ, Kelly EJ, Batchelor AG. The variation in breast density and
            analysis,  longer follow-up, and more  comprehensive   its relationship to delayed wound healing: a prospective study of 40
                                                                  reduction mammoplasties. J Plast Reconstr Aesthet Surg 2010;63:663-5.
            collection of operative and complication data.    13.  Chun YS, Schwartz MA, Gu X, Lipsitz SR, Carty MJ. Body mass index as
                                                                  a predictor of postoperative complications in reduction mammaplasty.
            In conclusion, the increasing number of obese patients   Plast Reconstr Surg 2012;129:e228-33.
            accompanied by their desire for breast reduction surgery   14.  Wagner  DS, Alfonso  DR. The  influence  of  obesity  and  volume  of
            poses a significant  challenge to surgeons.  To provide   resection on success in reduction mammaplasty: an outcomes study.
                                                                  Plast Reconstr Surg 2005;115:1034-8.
            optimal care and minimize surgical risk, understanding   15.  Setala  L,  Papp A,  Joukainen  S,  Martikainen  R,  Berg  L,  Mustonen  P,
            the role of obesity  in postoperative outcomes is     Härmä M. Obesity and complications in breast reduction surgery: are
            essential.  This  study  was able  to independently assess   restrictions justified? J Plast Reconstr Aesthet Surg 2009;62:195-9.
            obesity as a surgical risk factor for postoperative wound   16.  Roehl K, Craig ES, Gomez V, Phillips LG. Breast reduction: safe in the
                                                                  morbidly obese? Plast Reconstr Surg 2008;122:370-8.
            complications following reduction mammaplasty using   17.  Cunningham BL, Gear AJ, Kerrigan CL, Collins ED. Analysis of breast
            multivariate  analysis  and propensity  score  matching.   reduction complications derived from the BRAVO study. Plast Reconstr
            Obesity alone should not be the sole determining factor of   Surg 2005;115:1597-604.
            a patient’s surgical candidacy, but rather as a component   18.  Shiloach M, Frencher SK Jr, Steeger JE, Rowell KS, Bartzokis K, Tomeh
            of a complete preoperative evaluation. We recommend   MG, Richards KE, Ko CY, Hall BL. Toward robust information: data
            thorough risk stratification and patient counseling prior   quality and inter-rater reliability in the American College of Surgeons
                                                                  National Surgical Quality Improvement Program.  J  Am Coll Surg
            to surgical intervention.                             2010;210:6-16.
                                                              19.  Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and
            Financial support and sponsorship                     adult obesity in the United States, 2011-2012. JAMA 2014;311:806-14.
            Nil.                                              20.  Wang Y, Beydoun MA. The obesity epidemic in the United States  -
                                                                  gender, age, socioeconomic, racial/ethnic, and geographic characteristics:
                                                                  a  systematic review and  meta-regression  analysis.  Epidemiol Rev
            Conflicts of interest                                 2007;29:6-28.
            There are no conflicts of interest.               21.  Flegal  KM,  Kit  BK,  Orpana  H,  Graubard  BI. Association  of  all-cause
                                                                  mortality with overweight and obesity using standard body mass index
                                                                  categories: a systematic review and meta-analysis. JAMA 2013;309:71-
            REFERENCES                                            82.
                                                              22.  Cepeda MS, Boston R, Farrar JT, Strom BL. Comparison of logistic
            1.   American Society of Plastic Surgeons. 2014 Plastic Surgery Statistics   regression versus propensity score when the number of events is low
                Report.  Available  from: http://www.plasticsurgery.org/Documents/  and there are multiple confounders. Am J Epidemiol 2003;158:280-7.
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