PURPOSE:
The definition of obesity is ill defined in the plastic surgery literature for reduction mammaplasty patients. This unclear obesity classification hinders inter-study comparison for the previously reported relationships between both obesity and the amount of breast tissue resected on complication rates. The calculated body mass index (BMI) is an unambiguous anthropometric tool that can stratify obesity as determined by the National Heart, Lung, and Blood Institute’s (NHLBI) Obesity Education Initiative Expert Panel. We established a prospective single surgeon bilateral reduction mammaplasty database to investigate our hypothesis that increasing BMI should increase risks for anesthesia, wound healing, cardiopulmonary or cerebravascular complications. In addition, we utilized the positive relationship between increasing BMI and breast weight to determine if a threshold amount of breast tissue resected exists leading to adverse outcomes.
METHODS: From 1999 to 2005, 350 women underwent bilateral reduction mammaplasty by a single surgeon. This database represents the largest obese population studied to date for bilateral reduction mammaplasty (n = 261 for BMI > 30 with BMI ranging from 20.5 to 73.9). Preoperative patient variables recorded were age, smoking status, approximate breast weight, preoperative ASA physical status, and patient measurements (suprasternal notch to nipple and inframammary fold to nipple). Operative technique was either free nipple grafting or the inferior pedicle Wise pattern technique. Statistical Package for the Social Sciences (SPSS, Inc. Chicago, Illinois) software was applied to our patient population for statistical analysis. Continuous variables were analyzed with 1-way ANOVA and the linear regression method. Categorical variables were evaluated using chi square analysis.
RESULTS: Neither body mass index, nor amount of breast tissue resected were significantly related to complication rates (p<.001).
CONCLUSION: Nearly 60 million adults in the U.S. are obese; 9 million are severely obese. A significant number of these obese women seek symptomatic relief through reduction mammaplasty, an elective procedure performed on 150,000 women in the USA annually. This obese population undergoing reduction mammaplasty necessitates added preoperative, operative and postoperative considerations due to the co morbidities associated with obesity. We have shown that with the proper multidisciplinary preoperative risk assessment obesity alone should not contraindicate surgery. Furthermore, previously published studies should not limit decision making in the amount of breast tissue to resect if BMI necessitates a larger specimen.