Twenty Years of Breast Reduction Surgery at a Veterans Affairs Medical Center
Background: Breast reduction surgery has a high patient satisfaction rate for the treatment of symptomatic macromastia. However, complications from the surgery can significantly disrupt a woman’s life due to time in the hospital, clinic appointments, wound care, time off work, and poor aesthetic outcome. Beginning July 2007, the Malcom Randall Veterans Affairs Medical Center (MRVAMC) Plastic Surgery Service in Gainesville, Florida, started using a preoperative screening protocol to help patients achieve a healthier and more favorable risk profile.
Methods: A retrospective chart review was conducted on all breast reduction surgeries performed at the MRVAMC from July 1, 2000 to June 30, 2020. Medical records were queried for all primary breast reduction surgeries performed for symptomatic macromastia. Potentially modifiable or predictable risk factors for wound complications were recorded: nicotine status, body mass index (BMI), diabetes mellitus (DM) status, skin incision pattern, and pedicle location. Records were reviewed for 3 months after surgery for local wound complications that included: hematoma, infection, wound breakdown, skin and nipple necrosis. Major complications required an unplanned hospital admission or operation.
Results: Over the 20-year period, 115 bilateral breast reduction surgeries were performed. There were 48 wound complications (41.7%) and 8 major complications (7%). Most complications were identified in the first 7 years of the study. BMI > 32 ( P = .03) and active nicotine use ( P = .004) were found to be statistically significant risk factors for wound complications. DM status ( P = .22), skin incision pattern ( P = .25), and pedicle location ( P = .13), were not predictors of wound complications.
Conclusions: Breast reduction surgery has a high wound complication rate, which can be predicted and improved upon so that patients can receive their indicated surgery with minimal inconvenience and downtime. This review confirms that preoperative weight loss and nicotine cessation were the appropriate focus of the MRVAMC Plastic Surgery service’s efforts to achieve a safer surgical experience.
Limitations and Strengths
This retrospective review comprised multiple different surgeons, including faculty and trainees, who were involved in the consultation, surgery, and postoperative care of the patients over a 20-year period; therefore, consistency in documentation is lacking. In addition, we were limited to only the information available on the charts. For example, wound size and laterality were not consistently documented. The MRVAMC complication rate was consistent with the current literature (range, 14-52%).12,18,20,24
The major strength of the study is that the veterans tend to stay within the VA, which makes complications easier to identify and follow. Patients who do not present initially to their surgeon due to travel limitations will typically contact their primary care provider or present to their local VA urgent care or emergency department provider, who will route the patient back to the surgical specialty service through the electronic health record.
Conclusions
Breast reduction surgery has a high wound complication rate, which can be predicted and improved on so that patients can receive their indicated surgical procedure with minimal inconvenience and downtime. This review confirms that preoperative weight loss and nicotine cessation were the appropriate focus of the MRVAMC plastic surgery service’s efforts to achieve a safer surgical experience. We will continue to enforce our protocol and encourage patients who are interested in breast reduction surgery and fall outside the requirements to work with their primary care provider on smoking cessation and weight loss through better nutrition and physical activity.
Acknowledgment
This manuscript is the result of work supported with resources and the use of facilities at the North Florida/South Georgia Veterans Health System in Gainesville, Florida.
