Breast reduction surgery has generally a very high satisfaction rate. However, like any surgery, there are risks involved that can adversely affect a successful outcome. In order to minimize risks and maximize recovery, certain steps can be taken to avoid wound healing problems and ensure a fast recovery with excellent results
Have a Safe BMI prior to surgery
For most plastic surgeries, a rule of thumb is a BMI of 30 or less prior to the procedure. This will keep patients in the overweight category but not obese category prior to surgery. Studies have shown that a BMI of 35 or less has no increased risk in wound healing.
Carefully Plan the position of the Nipple-Areola
Most reductions are able to place the nipple-areola complex to about 21 cm from the sternal notch for optimal results. This gives a pleasing results in most reductions. However, in larger reductions, doing this can put excess tension on the nipple-areola tissues resulting in wound healing or possible nipple loss. In larger reductions, accepting a slightly lower position of the nipple may avoid complications.
Limiting the Amount of Breast Tissue Resected
It is important to leave sufficient breast tissue underneath the nipple-areolar complex to avoid devascularizing this area. When resecting over 1000 gm of tissue per breast, it is important to ensure proper vascularity to this area and to carefully resect tissue in areas away from the proposed nipple-areolar pedicle. One useful technique to avoid blood supply injury is to reduce tissue with liposuction instead of direct excision, thereby reducing the risk of vascular compromise.
Not performing certain Breast Reductions under insurance
In insurance cases, the minimum amount of resected tissue required for insurance payments is usually around 500 gm. In smaller reduction patients, it may be risky to propose to do these cases under insurance as resecting this amount of tissue may lead to nipple loss or other wound healing complications. For this reason, an honest preoperative evaluation needs to be performed with the patient, having them understand that doing the procedure under insurance may lead to denial of coverage resulting in the patient being responsible for the cost of the procedure if not enough tissue is removed. In these cases, doing the procedure as a cosmetic fee for service procedure, may be financially more beneficial for the patient.
In patients with significant breast asymmetry, one breast may meet insurance requirements of 500 gm reduction but the other may not. This situation may also lead to denials since insurance companies require that both breasts meet the minimal excision amount requirement.
Reducing the Risk of Wound Healing Complications
Most breast reduction surgeries have excellent outcomes. Even then, some issues with wound healing may occur. Rates of delayed wound healing range from 10 to 40%; however, most of these resolve with local wound care and only 1% require reoperation.
To limit risks the surgeon should take extra precautions in patients having a BMI > 35, having resections of over 1000 gm, and those with nipple to inframammary fold distances over 20 cm. In addition, in patients with nicotine exposure, limiting this exposure for at least 2 weeks preoperatively and if possible 4 weeks preoperatively is appropriate. In diabetic patients, ensuring proper long-term glucose control prior to surgery is also recommended.
References:
Breast Resection Weight Prediction and Insurance Reimbursement in Reduction Mammaplasty: Which Scale Is Reliable? Yan, Maria M.D.; Bustos, Samyd S. M.D.; Kuruoglu, Doga M.D.; Manrique, Oscar J. M.D.; Tran, Nho V. M.D.; Sharaf, Basel A. M.D., D.D.S.; Harless, Christin A. M.D.; Martinez-Jorge, Jorys M.D.; Forte, Antonio J. M.D., M.S., Ph.D.; Nguyen, Minh-Doan T. M.D., Ph.D. Plastic and Reconstructive Surgery: October 2022 – Volume 150 – Issue 4 – p 723e-730e.
Effects of Comorbidities on the Inferior Pedicle Reduction Mammaplasty: A Statistical Analysis. Friedman, Harold I. M.D., Ph.D.; Schlub, Riley M.D.; Durkin, Martin M.D., M.P.H., M.A.S.; Clark, Emily M.D.; Gilstrap, Jarom M.D.; McGreevy, Donna R.N., B.S.N. Plastic and Reconstructive Surgery: October 2022 – Volume 150 – Issue 4 – p 742-752
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