Revisiting Reduction Mammaplasty: Complications of Oncoplastic and Symptomatic Macromastia Reductions

Background: Oncoplastic breast reduction has been shown to be an effective and safe approach to breast conservation surgery in women with macromastia. However, there remains a paucity of data investigating the comparative outcomes. This study seeks to delineate the complication profiles for oncoplastic and symmetrizing breast reductions versus mammaplasty for benign macromastia. Methods: A retrospective review was conducted of all consecutively performed reduction mammaplasty cases at a single institution by two plastic surgeons over a 2-year period. Results: A total of 632 breasts were analyzed: 502 reduction mammaplasties, 85 symmetrizing reductions, and 45 oncoplastic reductions in 342 patients. Mean age was 43.9 ± 15.93 years, mean body mass index was 29.15 ± 5.66 kg/m2, and mean reduction weight was 610.03 ± 313.13 g. Regarding surgical technique, a medial pedicle was used in 86% of cases. There were similar postoperative complication outcomes for nipple necrosis, wound healing, scar revision, fat necrosis, seroma, hematoma, and overall complication rates for all procedures. However, the rate of postoperative revision among reduction mammaplasty (2%), oncoplastic reduction (6.7%), and symmetrizing reduction (5.9%) was significantly different (P = 0.027). In univariate analysis, diabetes (P = 0.011), smoking (P = 0.007), higher body mass index (P = 0.003), larger reduction weight (P = 0.011), longer nipple-to–inframammary fold measurement (P = 0.014), and longer sternal notch–to-nipple measurement (P = 0.039) were all significant risk factors for a surgical complication in reductions performed for any indication. Using a multivariate logistic regression model, diabetes (P = 0.047), smoking (P = 0.025), and higher body mass index (P = 0.002) were all retained as statistically significant risk factors. Conclusion: The complication profiles for both oncoplastic breast reductions and breast reductions for symptomatic macromastia are similar and acceptably low. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

[1]  G. Robb,et al.  Immediate Contralateral Mastopexy/Breast Reduction for Symmetry Can Be Performed Safely in Oncoplastic Breast-Conserving Surgery , 2020, Plastic and reconstructive surgery.

[2]  Najeeb M. Halabi,et al.  Long-term Results After Oncoplastic Surgery for Breast Cancer: A 10-year Follow-up , 2017, Annals of surgery.

[3]  A. Losken,et al.  Updated Evidence on the Oncoplastic Approach to Breast Conservation Therapy , 2017, Plastic and reconstructive surgery.

[4]  A. Losken,et al.  Oncoplastic Breast Reduction Technique and Outcomes: An Evolution over 20 Years , 2017, Plastic and reconstructive surgery.

[5]  M. Brentani,et al.  The role of oncoplastic breast conserving treatment for locally advanced breast tumors. A matching case-control study , 2016, Annals of medicine and surgery.

[6]  H. Kuerer,et al.  Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction , 2016, Annals of Surgical Oncology.

[7]  A. Losken,et al.  Current Opinion on the Oncoplastic Approach in the USA , 2016, The breast journal.

[8]  G. Robb,et al.  Obese Women Experience Fewer Complications after Oncoplastic Breast Repair following Partial Mastectomy Than after Immediate Total Breast Reconstruction , 2016, Plastic and reconstructive surgery.

[9]  R. Orecchia,et al.  Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis , 2016, Annals of Surgical Oncology.

[10]  Frcs M. P. Tan MBBS.  Is there an Ideal Breast Conservation Rate for the Treatment of Breast Cancer? , 2016, Annals of Surgical Oncology.

[11]  M. Talmor,et al.  A Comparative Retrospective Analysis of Complications After Oncoplastic Breast Reduction and Breast Reduction for Benign Macromastia: Are These Procedures Equally Safe? , 2015, Annals of plastic surgery.

[12]  A. Losken,et al.  The Use of Reduction Mammaplasty with Breast Conservation Therapy: An Analysis of Timing and Outcomes , 2015, Plastic and reconstructive surgery.

[13]  A. Losken,et al.  A Meta-Analysis Comparing Breast Conservation Therapy Alone to the Oncoplastic Technique , 2014, Annals of plastic surgery.

[14]  A. Dunant,et al.  The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy. , 2013, Breast.

[15]  R. Ruberg.  A Head-to-Head Comparison of Quality of Life and Aesthetic Outcomes following Immediate, Staged-Immediate, and Delayed Oncoplastic Reduction Mammaplasty , 2013 .

[16]  M. Nahabedian,et al.  A Head-to-Head Comparison of Quality of Life and Aesthetic Outcomes following Immediate, Staged-Immediate, and Delayed Oncoplastic Reduction Mammaplasty [Outcomes Article] , 2011, Plastic and reconstructive surgery.

[17]  M. Gómez Fleitas,et al.  Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. , 2010, Surgical oncology.

[18]  F. Reyal,et al.  Oncoplastic Breast Surgery for Cancer: Analysis of 540 Consecutive Cases [Outcomes Article] , 2010, Plastic and reconstructive surgery.

[19]  A. Losken,et al.  The benefits of partial versus total breast reconstruction for women with macromastia. , 2010, Plastic and reconstructive surgery.

[20]  S. Kronowitz.  Oncoplastic breast surgery for cancer: Analysis of 540 consecutive cases , 2010 .

[21]  H. Kuerer,et al.  A Management Algorithm and Practical Oncoplastic Surgical Techniques for Repairing Partial Mastectomy Defects , 2008, Plastic and reconstructive surgery.

[22]  G. Catanuto,et al.  Outcomes of bilateral mammoplasty for early stage breast cancer. , 2008, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[23]  A. Losken,et al.  Management Algorithm and Outcome Evaluation of Partial Mastectomy Defects Treated Using Reduction or Mastopexy Techniques , 2007, Annals of plastic surgery.

[24]  P. Schrenk,et al.  Oncoplastic Techniques Allow Breast-Conserving Treatment in Centrally Located Breast Cancers , 2007, Plastic and reconstructive surgery.

[25]  P. Taourel,et al.  Comparative Study of the Accuracy of Breast Resection in Oncoplastic Surgery and Quadrantectomy in Breast Cancer , 2007, Annals of Surgical Oncology.

[26]  A. Luini,et al.  Comparative Study of Surgical Margins in Oncoplastic Surgery and Quadrantectomy in Breast Cancer , 2005, Annals of Surgical Oncology.

[27]  A. Brédart,et al.  Partial mastectomy: a balance between oncology and aesthetics? , 2005, The Lancet. Oncology.

[28]  K. Oberg,et al.  Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. , 2004, Plastic and reconstructive surgery.

[29]  S. Spear,et al.  Reduction mammaplasty in conjunction with breast conservation. , 2004, Seminars in plastic surgery.

[30]  N. Johnson,et al.  Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia. , 2004, American journal of surgery.

[31]  A. Wilson,et al.  Cosmesis and satisfaction after breast‐conserving surgery correlates with the percentage of breast volume excised , 2003, The British journal of surgery.

[32]  C. Nos,et al.  Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas , 2003, Annals of surgery.

[33]  G. Robb,et al.  Reduction mammoplasty improves breast conservation therapy in patients with macromastia. , 2001, American journal of surgery.

[34]  P Okunieff,et al.  Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. , 1995, The New England journal of medicine.