Impact of Age, Body Mass Index, and Resection Weight on Postoperative Complications in Reduction Mammaplasty.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Early versus Delayed Implant Exchange after Periprosthetic Breast Infection: A Single Center Study.

BACKGROUND: Breast implant infections are challenging problems for both plastic surgeons and patients. They may require readmissions, re-operations, and have the potential to compromise the final result. Our goal was to determine whether early operative intervention (return to the operating room <72 h after diagnosis of infection) or intravenous antibiotics with later operative intervention increased long-term retention of a prosthesis. METHODS: A retrospective review was conducted of patients who were hospitalized or underwent reoperation for an infection from 2006 through 2016. The length of hospitalization, length of IV antibiotic use, and retention of the breast prosthesis at 3-months after reoperation were recorded for each patient. RESULTS: A total of 43 patients were included in our study. Of these, 33 patients underwent early intervention, and 10 patients underwent delayed intervention. The average length of stay was significantly shorter in the early versus delayed return to OR group (4.1 versus 6.4 days; P = 0.008). The average duration of antibiotics was shorter in the early intervention group than the delayed group (5.1 versus 6.4 days; P = 0.28). At 3-months postoperatively, a greater proportion of patients in the early intervention group compared with the delayed group retained their breast prostheses (87.5% versus 60%; P = 0.25). CONCLUSIONS: The results of this study demonstrate that breast implants may be salvaged after early (<72 hours) or delayed (>72 hours) operative intervention; however, early intervention is associated with a significantly shorter length of stay, and trends toward a shorter antibiotic course and higher rate of implant retention at 3 months.

Pre-expanded Deep Inferior Epigastric Perforator Flap.

The deep inferior epigastric perforator (DIEP) flap can be used to cover large defects of the proximal lower extremity, abdominal wall, perineum, vulva, and buttock. Pre-expanding DIEP flaps cause a possible delay phenomenon improving vascularity, decrease donor site morbidity, and increase the area that can be covered. Pre-expansion requires staged procedures, has risk of extrusion and infection, causes temporary contour deformity during the expansion process, and requires a longer course. Pre-expanded DIEP flaps can be a useful flap with proper patient selection and planning.

Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution.

BACKGROUND: In 2008, the authors' institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. OBJECTIVE: To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. METHODS: Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. RESULTS: The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). CONCLUSION: In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.

HISTORIQUE: En 2008, l'établissement des auteurs a adopté une politique selon laquelle toutes les patientes, quel que soit leur risque préopératoire, reçoivent à la fois des appareils de compression séquentielle et une unique injection préopératoire de 5 000 unités d'héparine sous-cutanée. La publication d'une analyse sur 12 ans réalisée au même établissement avant l'adoption de cette politique démontrait une incidence postopératoire d'hématomes de 1,5 % au bout de 30 jours après une augmentation mammaire primaire ou une reconstruction mammaire tardive avec expandeurs tissulaires. OBJECTIF: Déterminer l'incidence de complications hémorragiques postopératoires associées à l'administration préopératoire de 5 000 unités d'héparine sous-cutanée et la comparer aux données publiées. MÉTHODOLOGIE: Avec l'approbation du comité d'étude de l'établissement, les auteurs ont procédé à la collecte prospective des données des patientes et les ont conservées dans une base de données monocentriques sécurisée. Ils ont ensuite utilisé la terminologie à jour des interventions et les codes de la Classification statistique internationale des maladies, Neuvième révision pour déterminer, sur une période de cinq ans, toutes les patientes qui avaient subi une augmentation mammaire primaire ou une reconstruction mammaire tardive avec expandeurs tissulaires. Les résultats primaires étaient l'incidence de complication hémorragique postopératoire. Une complication hémorragique désignait tout événement hémorragique nécessitant une nouvelle opération. RÉSULTATS: L'incidence globale de grave hémorragie postopératoire était de 1,47 % (cinq cas sur 340 [1,16 % après l'augmentation, 2,50 % après l'expansion]). La comparaison des résultats récents avec les données publiées a démontré un rapport de cotes de 0,98 (95 % IC 0,38 à 2,55). CONCLUSION: Chez les femmes qui subissent une augmentation mammaire primaire ou une reconstruction mammaire tardive avec expandeurs tissulaires, la prophylaxie à l'héparine n'accroissait pas le risque de grave hémorragie postopératoire par rapport aux sujets témoins rétrospectifs.