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11/27/2011 01:48 AM

Breast Reduction Riskier After 50

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Breast Reduction Riskier After 50

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: November 23, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine.

■Note that breast reduction surgery is associated with a relatively high rate of complications, and factors associated with impaired outcomes include obesity, weight of resected tissue, and tobacco use.

■Point out that this single-center study identified older age as a factor associated with a high rate of infection.

Outcomes of breast reduction surgery worsen with age, with more infections and a tendency toward wound-healing problems in women older than 50, researchers found.

The odds of infection were 2.7-fold higher for women over 50 (P=0.003), with a similar -- though not significant -- trend among women in their 40s (odds ratio 1.7, P=0.08), Michele A. Shermak, MD, of Johns Hopkins University, and colleagues reported in the December issue of Plastic and Reconstructive Surgery.

Women over 50 also tended to experience more wound-healing problems (OR 1.6, P=0.09) and require more reoperative wound debridement (OR 5.1, P=0.07) in the single-center series of more than 1,000 cases.

Body mass index in the obese range or higher, tobacco use, and weight of resected tissue greater than 1,000 grams are all well-known factors that impair outcomes after breast reduction surgery, the authors noted.

However, no studies have focused on the impact of age on breast reduction outcomes.

To further clarify the issue, the researchers analyzed data from 1,192 consecutive patients who had a total of 2,156 breast reduction procedures done by 17 plastic surgeons at Johns Hopkins over a decade.

Most of the reduction mammoplasties (62.8%) were done on women younger than 40. The rest were roughly split between women in their 40s (20.3%) and those 50 or older (16.9%).

The technique used most commonly was inferior pedicle with Wise pattern (58.9%), followed by medial pedicle with Wise pattern in 16.9%, superior pedicle with nipple graft in 14.4%, superior pedicle with vertical pattern in 9.7%, and liposuction in 0.14%.

Type of breast reduction technique didn't vary with age.

Complication rates were 14.9% for symptomatic scar,

12.4% for minor wound requiring dressings,

7.7% for fat necrosis,

7.2% for infection, and

1.3% for seroma.

Reoperation rates were 6.5% for scar revision,

1.3% for removal of fat necrosis, and

1% for wound debridement.

Older age at time of surgery didn't appear to impact fat necrosis or seroma development overall, though those under 50 tended to get less fat necrosis in large breast reductions of more than 2.2 pounds (1 kg) per breast with an odds ratio of 0.38 compared with older women (P=0.06).

Factors aside from age that impacted breast reduction outcomes included:

Body mass index, with 7% increased risk of infection per unit BMI (P<0.001)

•Prior hysterectomy or oophorectomy, which was associated with 3.4-fold higher risk of wound reoperation after adjustment for age and hormone supplementation (P=0.02)

•Hormone replacement therapy plus oral contraception, which showed a nonsignificant trend for reduced risk of postoperative infection (OR 0.48, P=0.076)

Given those factors, hormones could be one explanation for poorer breast reduction outcomes at older ages, the researchers noted.

"In the laboratory, topical estrogen has been found to optimize wound healing, a process thought to be related to estrogen's stimulation of growth factors," Shermak's group explained.

"Close questioning about factors that may cause hormonal deficiency such as history of hysterectomy/oophorectomy should be addressed, and hormone replacement therapy may be worth considering in this group of patients," they suggested in the paper.

Other explanations could be the effect of aging on the skin -- atrophy, progressive loss of function, increased vulnerability to the environment, and decreased homeostatic capability -- as well as on other processes needed for wound healing, such as cell proliferation and migration.

Limitations of the study included the single-center design and the use of administrative billing codes in medical records to identify patients.

The researchers reported having no conflicts of interest to disclose.

Primary source: Plastic and Reconstructive Surgery

Source reference:

Shermak MA, et al "Increasing age impairs outcomes in breast reduction surgery" Plast Reconstr Surg 2011; 128: 1182-1187.


Barry Gordon, MD - Nov 24, 2011

On the basis of treating testosterone deficiency (TD) for well over a decade, and currently seeing @ 1400 patients per month, this study is not at all surprising.

Humans begin to become catabolic, (progressively losing T), during their mid-twenties, and the literature tells us that by 40 most women have lost half of this vital hormone.

The difference in wound healing and post-operative recovery between catabolic patients and those who have become anabolic from T replacement (TR) is profound.

Add to that the markedly hastened and enhanced immune response in those on TR as compared to the weakened and sluggish response when T deficient, and it's no wonder the findings of this study.

We can even look at the listed associated factors. Obesity is, in part, a manifestation of TD. Bilateral oophorectomy results in extreme TD.

I'm confused by the last associated factors. Did “hormone replacement” ever include T?

Why are a significant number of women over 50 taking oral contraceptives?

The day will come when not pre-treating elective surgery patients with T will be considered malpractice, and the sooner the better.

E. Barry Gordon, MD


I was 37, overweight, when I had my breast reduction of having 5.5 lbs. removed. NON-SMOKER.

My 1 breast they didn't get all the bleeders, so had to have another surgery late evening to stop the bleeding.

This breast drained for 1 YEAR with my going weekly to the surgeon checking and putting the cotton tip swab in there with a solution.

Scar tissue is horrible on both breasts; so very painful and so is light touching.


BettyG, Iowa

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Post edited by: Bettyg, at: 11/27/2011 01:56 AM


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