Friedman Harold I, Schlub Riley, Durkin Martin, Clark Emily, Gilstrap Jarom, McGreevy Donna
From Division of Plastic Surgery, Prisma Health/University of South Carolina School of Medicine.
Plast Reconstr Surg. 2022 Oct 1;150(4):742-752. doi: 10.1097/PRS.0000000000009532. Epub 2022 Jul 22.
Multiple studies have analyzed the impact of comorbidities on breast reduction surgery with mixed results. The purpose of this investigation was to perform a statistical analysis of all complications by a single surgeon, using a single technique for breast reduction.
Records of patients undergoing breast reduction from 1984 to 2019 with an inferior pedicle were reviewed. Comorbidities analyzed included hypertension, diabetes, nicotine use, weight of breast tissue resected, pedicle length, and basal metabolic index. The literature on the effects of comorbidities on outcomes for breast reconstruction was also reviewed.
Although increasing body mass index significantly increased the rate of fat necrosis, it did not impact those patients requiring reoperation for this complication. Body mass index greater than 35 kg/m 2 , weight of tissue resection greater than 1000 g, and nipple-to-inframammary fold distance greater than 20 cm all increased the odds ratio of having a breast with some fat necrosis. Increasing body mass index increased the risk of wound healing problems (both major and minor), but not for patients requiring reoperation. Body mass index greater than 35 kg/m 2 , breast tissue resection greater than 1000 g, and nipple-to-inframammary fold distance greater than 20 cm only minimally increased the odds ratio for a major wound complication.
Patients with increased body mass index are at greater risk for fat necrosis and wound healing complications. However, these usually can be managed conservatively in patients undergoing inferior pedicle breast reduction. Patients do not require free nipple grafting. The use of nicotine or the presence of diabetes or hypertension does not impact outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
多项研究分析了合并症对乳房缩小手术的影响，结果不一。本研究的目的是对一位外科医生采用单一技术进行乳房缩小手术的所有并发症进行统计分析。
回顾了1984年至2019年采用下蒂法进行乳房缩小手术患者的记录。分析的合并症包括高血压、糖尿病、吸烟情况、切除的乳腺组织重量、蒂的长度和基础代谢指数。还回顾了关于合并症对乳房重建结果影响的文献。
虽然体重指数增加显著增加了脂肪坏死的发生率，但对因该并发症需要再次手术的患者没有影响。体重指数大于35kg/m²、组织切除重量大于1000g以及乳头至乳房下皱襞距离大于20cm均增加了出现某种程度脂肪坏死乳房的比值比。体重指数增加会增加伤口愈合问题（包括严重和轻微问题）的风险，但对需要再次手术的患者没有影响。体重指数大于35kg/m²、乳腺组织切除大于1000g以及乳头至乳房下皱襞距离大于20cm仅轻微增加了严重伤口并发症的比值比。
体重指数增加的患者发生脂肪坏死和伤口愈合并发症的风险更高。然而，在接受下蒂法乳房缩小手术的患者中，这些通常可以保守处理。患者不需要游离乳头移植术。吸烟、糖尿病或高血压的存在不影响手术结果。
临床问题/证据级别：风险，III级。
