Abstract
Background
Breast reduction is a common procedure used to improve physical and aesthetic factors associated with breast hypertrophy. This study investigated how surgical technique alone affects the risk factors for complications and profiled differences between techniques. Complications were assessed by the use of time-to-event methods.
Methods
Patient information was extracted from a cohort of 283 patients. Demographic, surgical, and follow-up information was analyzed for patients undergoing surgical procedures using the inferior pedicle Wise pattern (IPWP) and modified Hall-Findlay (MHF) techniques. The patients managed with the IPWP technique were considered control subjects. The failure rates were described using the Kaplan–Meier failure estimator to provide a true estimate of the experienced complication rates.
Results
Overall, few differences were noted between the groups except for total tissue removed. The overall failure (complication) rate at 6 months was 18.8%, with 9% of all the patients experiencing a major complication that required operative intervention/revision. As expected, the period with the greatest risk of complication was the first month after surgery. Surgical technique, total tissue removed, and age were nonpredictive of complications. Overall, the IPWP group had significantly more total tissue removed than the MHF group (median difference, 227 g; P = 0.002). There was no evidence of a learning curve when an experienced surgeon moved from the one technique to the other.
Conclusion
At 6 months after surgery, 19% of patients are expected to have experienced a complication. There appears to be few differences in outcomes between the techniques of breast reductions used, and the success or otherwise almost certainly relates to factors independent of surgical technique and includes patient selection, operative skill, and experience. Time-to-event analysis provides a precise assessment and description of the complication profile.
Level of Evidence III
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References
Davis GM, Ringler SL, Short K, Sherrick D, Bengtson BP (1995) Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction. Plast Reconstr Surg 96:1106–1110
Chao JD, Memmel HC, Redding JF, Egan L, Odom LC, Casas LA (2002) Reduction mammaplasty is a functional operation, improving quality of life in symptomatic women: a prospective, single-center breast-reduction outcome study. Plast Reconstr Surg 110:1644–1652; discussion 53–54
Shakespeare V, Postle K (1999) A qualitative study of patients’ views on the effects of breast-reduction surgery: a 2-year follow-up survey. Br J Plast Surg 52:198–204
Fryzek JP, Ye W, Nyren O, Tarone RE, Lipworth L, McLaughlin JK (2006) A nationwide epidemiologic study of breast cancer incidence following breast-reduction surgery in a large cohort of Swedish women. Breast Cancer Res Treat 97:131–134
Boice JD Jr, Friis S, McLaughlin JK, Mellemkjaer L, Blot WJ, Fraumeni JF Jr et al (1997) Cancer following breast-reduction surgery in Denmark. Cancer Causes Control 8:253–258
Brinton LA, Persson I, Boice JD Jr, McLaughlin JK, Fraumeni JF Jr (2001) Breast cancer risk in relation to amount of tissue removed during breast-reduction operations in Sweden. Cancer 91:478–483
Robbins TH (1977) A reduction mammaplasty with the areola–nipple based on an inferior dermal pedicle. Plast Reconstr Surg 59:64–67
Cruz-Korchin N, Korchin L (2003) Vertical versus Wise pattern breast reduction: patient satisfaction, revision rates, and complications. Plast Reconstr Surg 112:1573–1578 (discussion 9–81)
Celebiler O, Sonmez A, Erdim M, Yaman M, Numanoglu A (2005) Patients’ and surgeons’ perspectives on the scar components after inferior pedicle breast-reduction surgery. Plast Reconstr Surg 116:459–464 (discussion 65–66)
Lassus C (1970) A technique for breast reduction. Int Surg 53:69–72
Hall-Findlay EJ (1999) A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 104:748–759 (discussion 60–63)
Chen CM, White C, Warren SM, Cole J, Isik FF (2004) Simplifying the vertical reduction mammaplasty. Plast Reconstr Surg 113:162–172 (discussion 73–74)
Lista F, Ahmad J (2006) Vertical scar reduction mammaplasty: a 15-year experience including a review of 250 consecutive cases. Plast Reconstr Surg 117:2152–2165 (discussion 66–69)
Hall-Findlay EJ (2002) Pedicles in vertical breast reduction and mastopexy. Clin Plast Surg 29:379–391
Ahmad J, Lista F (2008) Vertical scar reduction mammaplasty: the fate of nipple–areola complex position and inferior pole length. Plast Reconstr Surg 121:1084–1091
Kreithen J, Caffee H, Rosenberg J, Chin G, Clayman M, Lawson M et al (2005) A comparison of the LeJour and Wise pattern methods of breast reduction (comparative study). Ann Plast Surg 54:236–241 (discussion 41–42)
Robbins T (1984) Inferior pedicle breast-reduction technique. Plast Reconstr Surg 73:325
Atiyeh BS, Rubeiz MT, Hayek SN (2005) Refinements of vertical scar mammaplasty: circumvertical skin excision design with limited inferior pole subdermal undermining and liposculpture of the inframammary crease (review). Aesthet Plast Surg 29:519–531
StataCorp. (2009) Stata Statistical Software: Release 11.2. StataCorp LP, College Station, TX
Small KH, Tepper OM, Unger JG, Kumar N, Feldman DL, Choi M et al (2010) Redefining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty. J Plast Reconstr Aesthet Surg 63:346–353
Spector JA, Kleinerman R, Culliford ATt, Karp NS (2006) The vertical reduction mammaplasty: a prospective analysis of patient outcomes. Plast Reconstr Surg 117:374–381 (discussion 82–83)
Scott GR, Carson CL, Borah GL (2005) Maximizing outcomes in breast-reduction surgery: a review of 518 consecutive patients. Plast Reconstr Surg 116:1633–1639 (discussion 40–41)
Dex EA, Asplund O, Ardehali B, Eccles SJ (2008) A method to select patients for vertical scar or inverted-T pattern breast reduction. J Plast Reconstr Aesthet Surg 61:1294–1302
Zubowski R, Zins JE, Foray-Kaplon A, Yetman RJ, Lucas AR, Papay FA et al (2000) Relationship of obesity and specimen weight to complications in reduction mammaplasty. Plast Reconstr Surg 106:998–1003
James A, Verheyden C (2011) A retrospective study comparing patient outcomes of Wise pattern-inferior pedicle and vertical pattern-medial pedicle reduction mammaplasty. Ann Plast Surg 67(5):481–483
Behmand RA, Tang DH, Smith DJ Jr (2000) Outcomes in breast-reduction surgery. Ann Plast Surg 45:575–580
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Hunter-Smith, D.J., Smoll, N.R., Marne, B. et al. Comparing Breast-Reduction Techniques: Time-to-Event Analysis and Recommendations. Aesth Plast Surg 36, 600–606 (2012). https://doi.org/10.1007/s00266-011-9860-3
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DOI: https://doi.org/10.1007/s00266-011-9860-3