INTRODUCTION: Obese patients with symptomatic macromastia are requested to lose weight to comply with the medical policy coverage criteria for reduction mammaplasty.1 However, body weight has no impact on the benefits of reduction mammaplasty and it is not clear if preoperative weight loss results in a significant decrease in postoperative complications.2
METHOD: A prospective cohort study was performed to evaluate postoperative complications after reduction mammaplasty in obese women, defined as a body mass index (BMI) greater than 30. The patients were divided into 2 groups on the basis of preoperative weight loss, those who were successful at weight loss and those who were not successful. All obese women who presented to the Plastic Surgery Clinic for a reduction mammaplasty were invited to participate in the study, and the surgery was performed after giving the patients up to 6 months to attempt to lose weight in an effort to obtain medical insurance coverage for surgery. Diet and exercise were used by the patients to obtain weight loss. Data collection included demographic questions as well as the patient’s initial weight and height, patient’s weight at the time of surgery (amount of weight loss), bra cup size, if diabetic or smoker, breast specimen weight, and postoperative complications. The difference between the groups was evaluated using Student’s t test or chi-square, whichever was appropriate, with P value of <0.05 being considered significant. This study was approved by the Institutional Review Board.
RESULTS: This study evaluated 274 obese women who had reduction mammaplasty. Of the group, 123 (45%) had preoperative weight loss (mean, 27 ± 9 lbs) and 151 (55%) had no weight loss. The groups were not significantly different in age (29 ± 10 versus 28 ± 11; P > 0.05), initial BMI (34 ± 2 versus 33 ± 3; P > 0.5), bra cup size (DD versus DD), frequency of diabetes (5% versus 4%; P > 0.05), frequency of smokers (2% versus 2%; P > 0.0.05), and weight of breast tissue resection (911 ± 129 versus 927 ± 113 g; P > 0.05). At the time of surgery, the mean BMI of the group that loss weight was 30 ± 2 and of the group that had no weight loss was 33 ± 3. No significant difference was noted between the groups regarding postoperative complications such as surgical site infection (9% versus 8%; P > 0.05), fat necrosis (5% versus 5%; P > 0.05), and nipple necrosis (4% versus 5%; P > 0.05). There were no significant differences in the need for revisions or reoperations (3% versus 3%; P > 0.05). There were no deaths or major systemic complications in either group.
CONCLUSION: Our findings indicate that preoperative weight loss does not significantly decrease the complication rate of reduction mammaplasty in obese women. The mean attainable change in BMI prior to surgery does not appear to result in a significant change in postoperative complications.
REFERENCES:
1. Nguyen JT, Wheatley MJ, Schnur PL, et al. Reduction mammaplasty: a review of managed care medical policy coverage criteria. Plast Reconstr Surg. 2008;121:1092–1100.
2. Wagner DS, Alfonso DR. The influence of obesity and volume of resection on success in reduction mammaplasty: an outcome study. Plast Reconstr Surg. 2005;115:1034–1038.