|89th Annual Meeting Abstracts
Increasing Age Impairs Outcomes in Breast Reduction Surgery
Michele A. Shermak, M.D., Kate Buretta, B.A., Suhail Mithani, M.D., David Chang, Ph.D., MPH, MBA, Jessie Mallalieu, P.A.-C, Michele A. Manahan, M.D..
Johns Hopkins Hospital, Baltimore, MD, USA.
PURPOSE: Increasing age challenges optimal surgical outcomes, providing increasing risk for wound healing problems. While multiple breast reduction outcomes studies investigating poor prognostic indicators have been performed, none have specifically focused on the impact of age. In our breast reduction practice, we seemed to experience compromised surgical results despite a healthy profile in patients older than 40 years of age. We aimed to retrospectively study the impact of age on breast reduction outcome in a large cumulative experience of multiple plastic surgeons.
METHODS: Medical and operative records for all patients billed for CPT code 19318 over the past 10 years (1999-2009) at a large academic institution were analyzed under an IRB-approved protocol. Patient factors noted included age, medical comorbidities, tobacco use, prior breast reduction, BMI, breast reduction technique, and complications after surgery. Age groups were divided into: <40 years, 40 - 50 years, and > 50 years of age. Associations between patient factors and each of the outcome variables were examined by multiple logistic regression analysis, and was performed in Stata 10 (College Station, TX). Significance was defined as p value less than 0.05.
RESULTS: 1,192 consecutive patients underwent a total of 2156 reduction mammaplasties performed by 17 plastic surgeons at our institution over a 10 year period. We analyzed outcomes by breast and not by patient. Breast reduction techniques included: inferior pedicle with Wise pattern (n=1250, 58.6%); medial pedicle with Wise pattern (n=360, 16.9%); superior pedicle with nipple graft (n=305, 14.3%); superior pedicle with vertical pattern (n=206, 9.7%); and liposuction (n=3, 0.14%). Average age was 36 years, ranging from 13 to 79 years of age: 437 reductions were performed in women between 40 and 50 years old, and 365 for women > 50 years of age. Complications include: symptomatic scar (n=321, 15.3%); minor wound requiring dressings (n=267, 13.1%); fat necrosis (n=166, 7.9%); infection (n=156, 7.4%); and seroma (n=27, 1.3%). Reoperation was performed for scar revision (n=141, 6.7%); removal of fat necrosis (n=29, 1.4%); and wound debridement (n=21, 1%). Performing logistic multivariate analysis controlling for medical issues, smoking, secondary breast reduction and BMI, women over 40 years of age were more likely to experience postoperative infection, with age > 50 years reaching significance (p=0.001, OR=2.91). (See Table 1) Women from 40 - 50 years of age were more likely to experience postoperative seroma (p=0.044, OR=3.87). There was a trend toward wounds (p=0.089, OR=1.59) and need for reoperative debridement (p=0.075, OR=5.1) in women > 50 years of age. Advanced age did not exacerbate fat necrosis or scarring.
CONCLUSION: Age greater than 40 years, and particularly 50 years, represents an important factor impairing breast reduction outcomes, considering infection, seroma, wound healing problems and need for reoperative debridement. Hormonal deficiency may partially account for this finding and will be discussed. Age is an important factor to consider when planning breast reduction surgery and in consulting with patients.