Aesthetic Breast Surgery and Concomitant Procedures: Incidence and Risk Factors for Major Complications in 73,608 Cases

Varun Gupta; Max Yeslev; Julian Winocour; Ravinder Bamba; Charles Rodriguez-Feo; James C Grotting; K Kye Higdon

doi:10.1093/asj/sjw238

Aesthetic Breast Surgery and Concomitant Procedures: Incidence and Risk Factors for Major Complications in 73,608 Cases

Aesthet Surg J. 2017 May 1;37(5):515-527. doi: 10.1093/asj/sjw238.

Authors

Varun Gupta¹, Max Yeslev¹, Julian Winocour², Ravinder Bamba¹, Charles Rodriguez-Feo³, James C Grotting⁴, K Kye Higdon¹

Affiliations

¹ Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
² Plastic Surgery Fellow, Division of Plastic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
³ Resident, Department of Plastic Surgery, University of Washington, Seattle, WA, USA.
⁴ Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL, USA.

PMID: 28333172
DOI: 10.1093/asj/sjw238

Abstract

Background: Major complications following aesthetic breast surgery are uncommon and thus assessment of risk factors is challenging.

Objectives: To determine the incidence and risk factors of major complications following aesthetic breast surgery and concomitant procedures.

Methods: A prospective cohort of patients who enrolled into the CosmetAssure (Birmingham, AL) insurance program and underwent aesthetic breast surgery between 2008 and 2013 was identified. Major complications (requiring reoperation, readmission, or emergency room visit) within 30 days of surgery were recorded. Risk factors including age, smoking, body mass index (BMI), diabetes, type of surgical facility, and combined procedures were evaluated.

Results: Among women, augmentation was the most common breast procedure (n = 41,651, 58.6%) followed by augmentation-mastopexy, mastopexy, and reduction. Overall, major complications occurred in 1.46% with hematoma (0.99%) and infection (0.25%) being most common. Augmentation-mastopexy had a higher risk of complications, particularly infection (relative risk [RR] 1.74, P < 0.01), than single breast procedures. Age was the only significant predictor for hematomas (RR 1.01, P < 0.01). Increasing age (RR 1.02, P = 0.03) and BMI (RR 1.09, P < 0.01) were risk factors for infection. Concomitant abdominoplasty was performed in 4162 (5.8%) female patients and was associated with increased risk of complications compared to breast procedures or abdominoplasty performed alone. Among men, correction of gynecomastia was the most common breast procedure (n = 1613, 64.6%) with a complication rate of 1.80% and smoking as a risk factor (RR 2.73, P = 0.03).

Conclusions: Incidence of major complications after breast cosmetic surgical procedures is low. Risk factors for major complications include increasing age and BMI. Combining abdominoplasty with any breast procedure increases the risk of major complications.

Level of evidence: 2.

Publication types

Comparative Study

MeSH terms

Abdominoplasty / adverse effects*
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Body Mass Index
Child
Child, Preschool
Datasets as Topic
Emergency Treatment / statistics & numerical data
Female
Humans
Incidence
Male
Mammaplasty / adverse effects*
Mammaplasty / methods
Middle Aged
Patient Readmission / statistics & numerical data
Postoperative Complications / epidemiology*
Prospective Studies
Reoperation / statistics & numerical data
Risk Factors
Treatment Outcome
Young Adult