Complications and Quality of Life following Reduction Mammaplasty in Adolescents and Young Women

Laura C. Nuzzi, B.A.; Joseph M. Firriolo, M.D.; Carolyn M. Pike, M.S.N., M.P.H.; Amy D. DiVasta, M.D., M.M.Sc.; Brian I. Labow, M.D.

Disclosures

Plast Reconstr Surg. 2019;144(3):572-581. 

In This Article

Results

Baseline Demographics and Operative Information

A total of 512 subjects participated in our study. The mean age at surgery was 17.8 ± 1.9 years (Table 2). Our sample's mean right and left sternal notch–to-nipple distances were 29.5 ± 4.1 cm and 29.7 ± 4.6 cm, respectively. Most subjects were overweight or obese [n = 354 (69.1 percent)]. All patients underwent reduction mammaplasty using an inferior pedicle technique with Wise-pattern skin excision; median total tissue resection mass was 1394 g.

Early Postoperative Complications

Early complications were assessed within the first postoperative month, and data were available for all subjects (Table 3). No patient in our sample experienced deep vein thrombosis, pulmonary embolism, or major infection. The most common early complications included open wounds at the T junction [n = 20 (3.9 percent)], minor surgical-site infection [n = 12 (2.3 percent)], and seroma/hematoma [n = 12 (2.3 percent)]. The majority of patients with T-junction wounds [n = 17 of 20 (85.0 percent)] achieved complete wound closure in fewer than 6 weeks with dressing changes. Of those with delayed T-junction healing lasting 6 weeks or longer [n = 3 of 20 (15.0 percent)], two patients were managed with close monitoring and dressing changes, and one patient required débridement of necrotic tissue in clinic. All patients who developed a surgical-site infection were successfully treated with oral antibiotics. There was no association between surgical-site infection and obesity status (OR, 1.76; 95 percent CI, 0.56 to 5.55; p = 0.33). All patients with seroma/hematoma underwent successful drainage in the clinic [n = 7 of 12 (58.3 percent)] or the operating room [n = 5 of 12 (41.7 percent)]. There was no association between hematoma/seroma and obesity status (OR 1.25, 95 percent CI, 0.39 to 3.99; p = 0.71).

Late Postoperative Complications Beyond the First Postoperative Year

Postoperative sensory and late complications were assessed after the first postoperative year. Late postoperative sensory information was available for 346 subjects, with a median follow-up time of 18.0 months (minimum, 12.0 months; maximum, 89.9 months; interquartile range, 13.1 months) for these subjects (Table 4). A total of 27 patients (7.8 percent) reported partial breast hypesthesia and 29 patients (8.4 percent) had reported partial nipple-areola hypesthesia persisting beyond the first postoperative year. No patients experienced persistent absent breast or nipple sensation (anesthesia). One patient (0.3 percent) experienced persistent breast pain likely caused by a neuroma.

Late postoperative complication information was available for 225 subjects (Table 5). The most common wound healing complication after the first postoperative year was hypertrophic scarring [n = 45 (20.0 percent)]. Comparatively, keloids were less common in our sample [n = 11 (4.9 percent)]. A significantly higher proportion of black/African American patients developed at least one keloid compared with all other racial categories (p = 0.04). Of note, roughly 19 percent of patients with expected, normal scarring voiced concern with their scar appearance. As part of our standard of care, all patients with hypertrophic scarring, keloids, or scar concerns were offered treatment; of these, 51 of 93 patients (54.8 percent) underwent scar revision and 14 of 93 patients (15.1 percent) received steroidal injection.

Postoperative Breast Growth

A total of 12 patients (5.3 percent) experienced postoperative breast growth that resulted in dissatisfaction or the reoccurrence of baseline macromastia-related symptomatology, or necessitated repeated reduction mammaplasty. Seven of our 12 patients (58.3 percent) experienced a return of baseline breast-related symptomatology, of which three patients underwent a secondary reduction mammaplasty and four patients were considering a second operation at the time of their last clinic visit. Five patients (41.7 percent) with postoperative breast growth remained asymptomatic but found the increased size aesthetically bothersome. Median amount of tissue resected, median age at surgery, and baseline body mass index category distribution did not vary significantly by regrowth status (p > 0.05, all). Within-subject analyses comparing baseline and most recent body mass index category found no significant postoperative change in body mass index category in patients who experienced postoperative growth (p = 0.99) and in those who did not (p = 0.22).

Approximately one-third (n = 160) of all subjects experienced at least one postoperative complication. Complication status was not associated with age at surgery (OR, 1.21; 95 percent CI, 0.83 to 1.76; p = 0.33), body mass index category (OR, 0.73; 95 percent CI, 0.48 to 1.08; p = 0.12), or total tissue mass resected (OR, 0.78; 95 percent CI, 0.52 to 1.16; p = 0.22). White patients were 1.6 times more likely to develop a postoperative complication compared with all other racial categories (OR, 1.6; 95 percent CI, 1.10 to 2.36; p = 0.01).

Postoperative Health-related Quality of Life

A total of 207 subjects completed preoperative and postoperative health-related quality-of-life surveys, with a median follow-up time of 19.1 months (minimum, 12.0 months; maximum, 107.2 months; interquartile range, 30.6 months). When stratifying by complication status, patients with and without a complication had significant postoperative score improvements on the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, and in all eight 36-Item Short-Form Health Survey domains (p < 0.05, all) (Table 6). Patients who did not develop a complication had significant improvements in mean Eating-Attitudes Test-26 scores (baseline score, 10.7; postoperative score, 7.3; p = 0.001). The postoperative improvements in Eating-Attitudes Test-26 score for patients who developed a complication approached significance (baseline score, 8.5; postoperative score, 6.6; p = 0.05). It must be noted that both the preoperative and postoperative Eating-Attitudes Test-26 scores for both groups were considerably below the clinical threshold of 20, which would indicate disordered eating thoughts and behaviors.

When comparing postoperative survey scores by complication status, both groups performed comparably on all survey measures (p > 0.05, all) except the 36-Item Short-Form Health Survey domain for bodily pain. Patients with a complication experienced a more favorable mean bodily pain score than those without a complication (83.0 versus 78.8, respectively; p = 0.04).

Patients with an early complication had significant postoperative score improvements across all measures (p < 0.05, all). Although patients with late complications had significant gains in seven 36-Item Short-Form Health Survey domains and on the Rosenberg Self-Esteem Scale, the Breast-Related Symptoms Questionnaire, and the Eating-Attitudes Test-26 (p < 0.05, all), they had no postoperative improvement in the general health domain of the 36-Item Short-Form Health Survey (p = 0.18). Patients with postoperative breast growth had significant postoperative improvement in the role-physical domain of the 36-Item Short-Form Health Survey (p = 0.03) and Breast-Related Symptoms Questionnaire (p = 0.02), but experienced no postoperative change in seven 36-Item Short-Form Health Survey domains (i.e., physical functioning, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) and on the Rosenberg Self-Esteem Scale and Eating-Attitudes Test-26 (p > 0.05, all).

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