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Bilateral Breast Reduction Outcomes In Patients With Autoimmune Connective Tissue Disease
Gustavo A. Rubio, M.D., Seth R. Thaller, M.D., DM.D., F.A.C.S.
University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.

Purpose: Autoimmune connective tissue diseases (CTDs) are associated with a wide spectrum of soft tissue and systemic manifestations that may significantly impact outcomes in elective breast surgery. Purpose of this study was to evaluate whether CTDs are associated with an increased rate of complications following bilateral breast reductions.
Method: Nationwide Inpatient Sample (2006-2011) was queried to identify bilateral breast reduction cases. Patients with rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, Raynaud’s syndrome, psoriatic arthritis, or scleroderma were identified. Demographic factors, co-morbidities, and postoperative complications were compared to patients without CTD using student t-test, chi-square, and risk-adjusted multivariate logistic regression.
Results: A total of 22,653 bilateral breast reductions were performed during study period. Of these, 428 (1.9%) were performed in patients with CTD. Patients with CTD were older (50.5 vs 42.5 years, respectively) and had higher rates of co-morbidities compared to non-CTD patients (p<0.01). Postoperatively, patients with CTD experienced higher rates of wound infections (1.2% vs 0.2%, p<0.01), venous thromboembolism (2.3% vs 0.2%, p<0.01), and major medical complications (4.4% vs 1.8%, p<0.01) compared to non-CTD patients, respectively. On multivariate logistic regression analyses, CTDs were independently associated with increased risk of wound infection (OR 3.6, 95% CI 1.3-10.5), venous thromboembolism (OR 11.7, 95% CI 5.6-24.7), and other major medical complications (OR 1.8, 95% CI 1.1-3.0).
Conclusion: Patients with CTD are at significantly increased risk for complications following elective bilateral breast reduction. Such high risk patients require careful patient selection and strategies to minimize risk of serious postoperative complications including venous thromboembolism.


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