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Efficacy of A No Vertical Scar Breast Reduction Technique in Severely and Morbidly Obese Patients with Macromastia
Branko Bojovic, M.D.1, Simon G. Tablot, M.D.2, Tristan L. Hartzell, MD3, Rodney K. Chan, MD4, Julian J. Pribaz, MD5.
1Johns Hopkins Hospital, Baltimore, MD, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA, 3UCLA Medical Center, Los Angeles, CA, USA, 4US Army Institute of Surgical Research, Brook Army Medical Center, San Antonio, TX, USA, 5Brigham and Women's Hospital, Boston, MA, USA.

Efficacy of A No Vertical Scar Breast Reduction Technique in Severely and Morbidly Obese Patients with Macromastia
Branko Bojovic, MD1, Tristan L. Hartzell, MD2, Rodney K. Chan, MD3, Julian J. Pribaz, MD4.
1Johns Hopkins Hospital, Baltimore, MA, USA, 2UCLA Medical Center, Los Angeles, CA, USA
, 3US Army Institute of Surgical Research, Brook Army Medical Center, San Antonio, TX, USA, 4Brigham and Women’s Hospital, Boston, MA, USA.
PURPOSE:
The increased risks of operating on obese patients is well know. Due to these concerns, those who are severely obese (BMI >35) or morbidly obese (BMI >40) and have macromastia are often denied breast reduction surgery. These patients are assumed to have an increased risk of major complications (including nipple loss, wound breakdown, infection, and systemic complications) and are denied surgery or are offered a free-nipple grafting reduction technique. We believe that a no vertical scar breast reduction technique is safe, easily reproducible, expeditious, and aesthetically pleasing and can be offered to these patients to improve their quality of life. The purpose of this study is to assess the safety and efficacy of a no vertical scar breast reduction technique in this group of severely and morbidly obese patients.
METHODS:
We conducted a retrospective review of a single surgeon’s (JJP) 10-year experience with a no vertical scar breast reduction technique between January 2000 and December 2009. Information collected via electronic and paper chart review included demographics, BMI, past medical history, and intra-operative and post-operative complications, including nipple sensation changes or loss, wound healing issues, hematoma, seroma, and infection. Additionally, we examined for any trend towards post-operative weight loss, improvement in sleep apnea symptoms if present pre-operatively, length of hospital stay, and personal patient satisfaction. RESULTS:
Three hundred and forty three patients underwent unilateral or bilateral breast reductions during the study period. Sixty of these patients were included in the study group. Thirty-eight had a BMI of 35.0-39.9 and twenty-two had a BMI of 40.0 or higher. Mean BMI was 39.6 kg/m2 and highest recorded BMI was 59.4 kg/m2. The largest single amount of breast tissue removed was 3055 grams and 3380 grams from right and left breasts in the same patient, respectively. Nine (15%) patients had symptoms of sleep apnea pre-operatively and all of those patients reported subjective improvements post-operatively. Twenty-one (35%) patients had minor complications including cellulitis and superficial wound infections requiring local drainage and wound care. One (1.6%) patient required re-admission on POD #2 for pain control and one (1.6%) patient was admitted for pericarditis on POD#3. Sixty patients (100%) had preservation of nipple sensation post-operatively. No major complications including nipple loss, DVT or PE, myocardial infarction, or death were noted.
CONCLUSION:
Breast reduction can safely be performed in the severely and morbidly obese without the need for free-nipple grafting techniques and without major postoperative complications. However, patients who fall into this subset of obesity should be warned of the 35% rate of minor complications and the resulting local wound care required.


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