1
|
Knoedler S, Perozzo FAG, Jiang J, Kosyk M, Alfertshofer M, Schenck TL, Kern B, Sofo G, Knoedler L, Panayi AC, Pomahac B, Kauke-Navarro M, Kim BS. The impact of age on outcomes after breast reduction surgery - A multi-institutional data analysis of 40,958 cases. J Plast Reconstr Aesthet Surg 2024; 98:318-330. [PMID: 39321535 DOI: 10.1016/j.bjps.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Reduction mammoplasty is popular among people of various age groups, yet the impact of age on postoperative outcomes remains debated. METHODS The American College of Surgeons National Surgical Quality Improvement Program (2008-2021) was queried to identify adult female patients who underwent reduction mammoplasty. Patients were categorized into 10-year age brackets (i.e., 18-29, 30-39, 40-49, 50-59, 60-69, and >70 years). We compared age-dependent 30-day outcomes via confounder-adjusted multivariate analyses. RESULTS 40,958 female patients (mean age: 41 ± 14 years and mean body mass index: 31 ± 6.1 kg/m²) were identified. Complications occurred in 6.4% (n = 2635) of cases, with 770 (1.9%) and 483 (1.2%) patients requiring reoperation and readmission, respectively. 1706 (4.2%) women experienced surgical complications, whereas medical complications were generally rare (n = 289; 0.7%). Compared with women aged 18-29 years, risks of any, surgical, and medical complications were higher for patients aged 30-39 years (OR: 1.22, p < 0.01; OR: 1.05, p = 0.51; OR: 1.84, p < 0.01), 40-49 years (OR: 1.34, p < 0.01; OR: 1.17, p = 0.04; OR: 1.54, p = 0.03), 50-59 years (OR: 1.45, p < 0.01; OR: 1.31, p < 0.01; OR: 1.78, p < 0.01), 60-69 years (OR: 1.38 years, p < 0.01; OR: 1.29, p = 0.01; OR: 1.71, p < 0.01), and >70 years (OR: 1.25, p = 0.18; OR: 1.01, p = 0.98; OR: 1.86, p = 0.14). Patients aged >30 years were also more likely to require readmissions and reoperations. CONCLUSION Patient age significantly affects outcomes after reduction mammoplasty, with the lowest risk in patients aged <30 years. Importantly, the association between age and postoperative morbidity was not linear. These findings can help guide informed decisions, recognizing that while age is a factor, it is not the sole determinant of risk.
Collapse
Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Filippo A G Perozzo
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jun Jiang
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mychajlo Kosyk
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Michael Alfertshofer
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Barbara Kern
- Department of Plastic Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Giuseppe Sofo
- Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Brazil
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
2
|
Figueroa AE, Yau A, Lentskevich MA, Termanini K, Gosain AK. Timing of Pediatric Breast Reduction and Insurance Coverage: Single-institution Retrospective Study. Plast Reconstr Surg Glob Open 2024; 12:e6147. [PMID: 39258280 PMCID: PMC11384872 DOI: 10.1097/gox.0000000000006147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/17/2024] [Indexed: 09/12/2024]
Abstract
Background Although long-term benefits of reduction mammaplasty have been proven, the appropriate age for adolescent reduction mammaplasty has been highly debated due to possible need for revision surgery. Practitioners often delay offering breast reduction to adolescents below age 18 based on presumed insurance denial. We reviewed trends in insurance denial at a single children's hospital to analyze whether age and/or insurance carriers have a significant impact on coverage of breast reduction. Methods A retrospective chart review from 2012 to 2022 of cisgender female patients with macromastia aged 12-20 years at the time of diagnosis was analyzed for differences in breast reduction insurance coverage based on age and body mass index at the time of diagnosis, referral to plastic surgery, and surgery. Results A total of 121 cisgender women were included. There were no significant differences in the mean ages of patients who underwent breast reduction versus those who did not (16.46 years versus 16.96 years, respectively; P = 0.089), or in the mean body mass index for patients who did versus those who did not receive breast reduction (28.58 kg/m² versus 29.05kg/m², P = 0.382). Furthermore, there were no significant differences in the proportion of patients undergoing breast reduction by age (P = 0.200) or by insurance class (P = 0.403). Conclusion Although insurance varies with carrier, the present findings suggest that surgeons need not delay in facilitating preauthorization for breast reduction in symptomatic patients presenting anytime during their teenage years.
Collapse
Affiliation(s)
- Ariel E Figueroa
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Alice Yau
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Marina A Lentskevich
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Kareem Termanini
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Arun K Gosain
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| |
Collapse
|
3
|
Ockell J, Biörserud C, Fagevik Olsén M, Elander A, Hansson E. "Normal" breast dimensions in obese women-reference values and the effect of weight loss. J Plast Reconstr Aesthet Surg 2024; 94:187-197. [PMID: 38810359 DOI: 10.1016/j.bjps.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Breast hypertrophy may cause significant suffering, such as back- and breast pain, painful shoulder groves, and eczemas. Furthermore, women with breast hypertrophy may have lower quality of life than women without breast hypertrophy. Although 50% of the women undergoing breast reduction in the US have body mass index (BMI) >30 kg/m2, the current standard of normality is based on studies focusing on women <40 years of age and BMIs <25 kg/m2. This study aimed to present reference values for breast measurements for women with obesity and to investigate the relationship between BMI loss and each breast measurement. MATERIALS AND METHODS One hundred and six women underwent laparoscopic Roux-en-Y gastric bypass in Gothenburg, Sweden. The participants' breast anthropometrics were measured before and after bariatric surgery and their perception of the skin on their breasts was measured using the Sahlgrenska Excess Skin Questionnaire. RESULTS Breast volume, sternal notch to nipple (SNN) distance, and ptosis increased significantly with increasing BMI. For instance, women with BMIs between 30-34.9 kg/m2 have a mean breast volume of approximately 770 ml, those with BMIs of 40-44.9 kg/m2 have approximately 1150 ml, and those with BMIs above 50 kg/m2 have approximately 1400 ml. Furthermore, the percent change in the respective breast measurements relative to percent BMI change can be predicted, for instance, with a 20% reduction in BMI, the breast volume, SNN-distance, and ptosis decrease by 25%, 4%, and 20% respectively. CONCLUSIONS This article presents the first standard of normality for breast anthropometrics in women with obesity and a model for predicting the change in breast anthropometrics relative to BMI. CLINICAL TRIAL REGISTRATION This is a longitudinal observation study, registered https://fou.nu/is/gsb/ansokan/49651, No: VGFOUGSB-49651. Trial registry name: "Överskottshud efter överviktskirurgi - dess utveckling samt behov och effekt av plastikkirurgi" ("Excess skin after bariatric surgery - its development and the need and effect of plastic surgery").
Collapse
Affiliation(s)
- Jonas Ockell
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christina Biörserud
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Box 455, 405 30 Göteborg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Physiotherapy, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, The Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, The Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| |
Collapse
|
4
|
Kim DK, Wright MA, Ascherman JA. Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery: Effects on Operative Times, Surgical Outcomes, and Procedure Charges. Ann Plast Surg 2024; 92:S150-S155. [PMID: 38556665 DOI: 10.1097/sap.0000000000003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Use of the absorbable deep dermal stapler in wound closure has become more common in plastic surgery because of its possible reduction in operative times and subsequent decrease in operative room costs. In this study, we examine the effects of this stapler on operative times and postoperative complications in bilateral reduction mammaplasties. METHODS A retrospective, observational cohort study was conducted via electronic chart review on patients who underwent bilateral reduction mammaplasties. Patients were stratified by wound closure method. One group was closed with sutures only, and in the other group, deep dermal staples were used during closure of the inframammary fold incision. Incidences of patient comorbidities and postoperative complications were compared. In addition, a financial cost analysis was performed. RESULTS The final patient cohort included 62 patients. Operative time was reduced by an average of 21.8 minutes when using deep dermal staples during closure, compared with when closing solely with sutures (P = 0.032). When controlling for mass of breast tissue removed and type of pedicle, deep dermal staple closure still predicted a reduction of 26.5 (SE, 9.9) minutes in operative time (P = 0.010). Postoperative complications were not affected by wound closure method (odds ratio, 4.36; 95% confidence interval, 0.91-31.7, P = 0.087). Though not statistically significant, financial charge was decreased with usage of deep dermal staples (P = 0.34). CONCLUSIONS Use of absorbable deep dermal staples produces a significant decrease in operative time for reduction mammaplasties with no increase in postoperative complication rates.
Collapse
Affiliation(s)
- Dylan K Kim
- From the Division of Plastic Surgery, Department of Surgery, Columbia University Irving, Medical Center, New York, NY
| | | | | |
Collapse
|
5
|
Estler A, Zanderigo E, Wessling D, Grözinger G, Steinmacher S, Daigeler A, Jorge C, Santos Stahl A, Feng YS, Schipperges V, Nikolaou K, Stahl S. Quantification of Breast Volume According to age and BMI: A Three-Dimensional MRI Analysis of 400 Women. Aesthetic Plast Surg 2023; 47:1713-1724. [PMID: 36418548 DOI: 10.1007/s00266-022-03167-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Breast size alteration is the most common aesthetic surgical procedure worldwide. This study aimed to assess the correlation between breast volume and BMI or age. MATERIALS AND METHODS The analyses were conducted utilizing 400 patients selected by a retrospective review of the archives at our institution. Epidemiological data and medical history were assessed. Adjusting for the age and BMI of patient from previously described cohorts, we calculated mean breast volumes per side and differences from the upper and lower percentiles to the mean volumes. RESULTS The patients had a median BMI of 23.5 (range: 14.7-45.6) and a median age of 51 (range: 24-82). The average total breast volume increased strongly with BMI (r=0.834, p<0.01) and moderately with age (r=0.305, p<0.01). Within a BMI range of 18-24, breast volumes in the 8th and 18th percentile differ on average by about 50 ml. One BMI unit increase in women with breast sizes in the 10th percentile accounts for a breast volume difference of about 30 ml. CONCLUSION BMI strongly correlates with breast size. To achieve natural results, preoperative consultation and planning of aesthetic and reconstructive breast surgery must recognize BMI as a major determinant of average breast size. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Arne Estler
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany.
| | - Eloisa Zanderigo
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Daniel Wessling
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Sahra Steinmacher
- Department of Women´s Health, University Hospital of Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Plastic Hand and Reconstructive Surgery BG Trauma Centre Tübingen, Schnarrenbergstr 95, 72076, Tübingen, Germany
| | - Cristina Jorge
- Department of General-, Visceral-, Vascular-, and Paediatric Surgery, Saarland University Medical Centre, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | | | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Vincent Schipperges
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), University Hospital Freiburg, Freiburg, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Baden-Württemberg, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstr. 36, 66111, Saarbrücken, Germany
| |
Collapse
|
6
|
McNamara CT, Parry G, Netson R, Nuzzi LC, Labow BI. Validation of the Short-Form 36 for Adolescents Undergoing Reduction Mammaplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5075. [PMID: 37334394 PMCID: PMC10270539 DOI: 10.1097/gox.0000000000005075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023]
Abstract
Health-related quality of life improvements after reduction mammaplasty have been reported by patients. Although instruments exist for adults, a validated outcomes survey is not available for adolescents. This study aims to validate the Short-Form 36 (SF-36) for adolescents undergoing reduction mammaplasty. Methods Patients aged 12-21 years were prospectively recruited between 2008 and 2021 to unaffected or macromastia cohorts. Patients completed four baseline surveys: SF-36, Rosenberg Self-esteem Scale, Breast-related Symptoms Questionnaire, and Eating Attitudes Test. Surveys were repeated at 6 and 12 months postoperatively (macromastia cohort), and at 6 and 12 months from baseline (unaffected cohort). Content, construct, and longitudinal validity were assessed. Results A total of 258 patients with macromastia (median age: 17.5 years), and 128 unaffected patients (median age: 17.0 years) were included. Content validity was established, and construct validity was fulfilled: internal consistency was confirmed for all domains (Cronbach alpha >0.7); convergent validity was satisfied through expected correlations between the SF-36 and Rosenberg Self-esteem Scale, Breast-related Symptoms Questionnaire, and Eating Attitudes Test, and known-groups validity was established through significantly lower mean scores in all SF-36 domains in the macromastia cohort compared with unaffected patients. Longitudinal validity was established by significant improvements in domain scores from baseline to 6 and 12 months postoperatively in patients with macromastia (P < 0.05, all). Conclusions The SF-36 is a valid instrument for adolescents undergoing reduction mammaplasty. Although other instruments have been used for older patients, we recommend the SF-36 when assessing health-related quality of life changes in younger populations.
Collapse
Affiliation(s)
- Catherine T. McNamara
- From the Adolescent Breast Clinic, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Gareth Parry
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Mass
- Harvard Medical School, Boston, Mass
| | - Rebecca Netson
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Laura C. Nuzzi
- From the Adolescent Breast Clinic, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Brian I. Labow
- From the Adolescent Breast Clinic, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| |
Collapse
|
7
|
Swedish Normative Scores for the BREAST-Q Reduction/Mastopexy Module. Aesthetic Plast Surg 2023; 47:73-80. [PMID: 35920862 PMCID: PMC9944676 DOI: 10.1007/s00266-022-03025-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Norm values for patient reported outcomes, that is knowledge about how the general population of women rate their breast-related satisfaction and quality of life, are necessary to interpret the meaning of scores. The aims of this study were to create Swedish normative values for the BREAST-Q reduction/mastopexy module and to describe what healthy women are most satisfied/dissatisfied with regarding their breasts. METHODS A random sample of 400 women aged 18-80, currently living in Region Västra Götaland, were sent BREAST-Q reduction/mastopexy. Descriptive data are presented. RESULTS One hundred and forty-six women answered the questionnaire (36.5%). Mean total scores ranged from 48 to 78. No clear changes in scores could be seen with age and women with a high BMI seem to be less satisfied with their breasts. The participants were most satisfied with the appearance of the breasts when dressed, the appearance in the mirror dressed, the shape of the breasts with bra, and symmetry of size and most dissatisfied with appearance in the mirror naked and the shape of the breasts without a bra. Thirty to forty-five per cent of healthy women never or almost never feel sexually attractive. Among physical symptoms often described in breast hypertrophy, the most common among healthy women were lack of energy, pain in the neck, arms and shoulders, headache and difficulty performing intense physical activity. CONCLUSION The norms for BREAST-Q reduction/mastopexy add another piece to the puzzle to what constitutes normal breast satisfaction and how surgical outcomes can be evaluated. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
8
|
Elder E. Time for equal access to breast reduction surgery in Australia. Med J Aust 2022; 216:138-139. [DOI: 10.5694/mja2.51386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
|