From the Division of Plastic Surgery, Baylor Scott & White Medical Center.
Texas A&M Health Science Center College of Medicine.
Plast Reconstr Surg. 2023 Apr 1;151(4):727-735. doi: 10.1097/PRS.0000000000009986. Epub 2022 Dec 5.
The authors seek to evaluate the impact of age, body mass index (BMI), and resection weight, on postoperative complications in women undergoing primary bilateral reduction mammaplasty.
A retrospective review of all primary bilateral reduction mammaplasties between February of 2014 and August of 2018 was performed. Patient demographics, medical comorbidities, tobacco use, BMI, operative technique, operative time, resection weight, and complications were reviewed.
Two hundred seventy-seven women were included. Mean age was 35.71 years, and BMI was 30.17 kg/m 2 . An inferior pedicle (53.07%) with Wise pattern resection (53.43%) was used most commonly. The minor complication rate was 49.1%, with superficial wounds (42.1%) occurring most commonly. Thirty-three women (11.9%) required greater than 2 months to heal. The major complication rate was 4.31%. BMI was not associated with minor or major complications on univariate analysis ( P = 0.1003 and P = 0.6163), but was associated with wound healing requiring greater than 2 months ( P = 0.0009), longer operative times ( P = 0.0002), and higher resection weights ( P < 0.00001). Greater age was associated with higher minor complication rates ( P = 0.0048). On multivariate analysis, BMI was associated with wound healing requiring greater than 2 months ( P = 0.0137), and age with minor complications ( P = 0.0180). No factors impacted major complication rates.
Women with higher BMI are more likely to require larger resections, longer operative times, and are at higher risk for wound healing requiring greater than 2 months. Although BMI is an important consideration for determining operative candidacy, the benefits of reduction may outweigh these risks in carefully selected patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
作者旨在评估年龄、体重指数（BMI）和切除重量对接受双侧原发性乳房缩小术的女性术后并发症的影响。
对 2014 年 2 月至 2018 年 8 月期间所有双侧原发性乳房缩小术进行回顾性分析。回顾患者的人口统计学资料、合并症、吸烟史、BMI、手术技术、手术时间、切除重量和并发症。
共纳入 277 名女性。平均年龄为 35.71 岁，BMI 为 30.17kg/m 2 。最常使用的是下蒂（53.07%）和 Wise 式切除术（53.43%）。轻微并发症发生率为 49.1%，最常见的是浅表伤口（42.1%）。33 名女性（11.9%）需要 2 个月以上才能愈合。严重并发症发生率为 4.31%。单因素分析显示，BMI 与轻微或严重并发症无关（P=0.1003 和 P=0.6163），但与需要 2 个月以上愈合的伤口有关（P=0.0009），与手术时间较长（P=0.0002）和切除重量较高有关（P<0.00001）。年龄较大与轻微并发症发生率较高有关（P=0.0048）。多因素分析显示，BMI 与需要 2 个月以上愈合的伤口有关（P=0.0137），年龄与轻微并发症有关（P=0.0180）。没有因素影响严重并发症的发生率。
BMI 较高的女性更有可能需要更大的切除量、更长的手术时间，并且更有可能出现需要 2 个月以上愈合的伤口。尽管 BMI 是决定手术适应证的重要因素，但在精心选择的患者中，减少的益处可能超过这些风险。
临床问题/证据水平：风险，III 级。
