Background: With an increasing obese population, plastic surgeons are consulted by women requesting larger breast reductions, with body mass indices in the obese to morbidly obese range (30 to ≥40 kg/m2) and breasts considered gigantomastic (>2000 g resected from each breast). There have been few descriptions of outcomes in the morbidly obese population. Previous literature reports high complication rates in obese women and large-volume breast reductions.
... We obtained data points including height, weight, preoperative symptoms, medical history, smoking history, breast size, physical examination, type of reduction, amount of resection, and postoperative course including complications. All complications were recorded, and included hematoma, seroma, asymmetry requiring further surgery, stitch abscess, open wounds, cellulitis, fat necrosis, flap loss, changes in nipple sensation, nipple loss, nipple graft loss, and hypertrophic scarring. All were recorded, with no gradation as to severity. These were recorded throughout the patient's follow-up course, ranging from 1 month to 1 year.
Average reduction mass -- 1259 gm per breast (117 - 4875 gm)
Average age -- 35 yrs (15 - 68 yrs)
Average body mass index -- 34 (range, 20.7 - 54.4)
World Health Organization: 18 to 24.9 kg/m2 (normal weight), 25 to 29.9 kg/m2 (overweight), 30 to 39.9 kg/m2 (obese), and greater than 40 kg/m2 (morbidly obese)
- 93 women in the obese category
- 34 women in the morbidly obese category
Delayed wound healing -- 65%
Cellulitis -- 17.6%
Hypertrophic scarring -- 8%
Hematoma -- 3%
Seroma -- 3%
Fat necrosis -- 3%
Nipple graft loss -- 1%
The overall complication rate was 50 percent.
There was no statistical difference in the incidence of complications attributable to size of reduction, age, or body mass index (p = 0.37, p = 0.13, and p = 0.38, respectively).Also, smoking status, method used (p = 0.65 and p = 0.17, and p = 0.48 and p = 0.1, respectively) andcomorbidities had no effect on complication rates (reduction size, p = 0.054; age, p = 0.12; and body mass index, p = 0.072).There was no significant increase in the rate of complications for each body mass index group based on the reduction mass (p = 0.75, p = 0.89, p = 0.23, and p = 0.07).