Medical journal reading update time. This month’s issue of PRS (plastic and reconstructive surgery journal) December 2011 had a study called “The Impact of Age on Breast Reduction.”
Breast reductions are a surgery I commonly perform. It is great –not just from the lift and cosmetic perspective– it is great from a health perspective. I have seen dramatic changes in neck pain, back pain, posture, and better body image. Any woman who takes off her bra and watches her breasts plummet to her waist, can’t jog because of the bounce, or has deep digs in her shoulders from her bra knows of what I speak.
This study is out of Maryland, led by Dr. Shermak at Johns Hopkins. In the introduction it states, “Despite the fact that complications after breast reduction surgery occur at a relatively high rate of 14-52%, breast reduction is one of the more commonly performed procedures in plastic surgery. ”
She goes on to state, well known factors impair outcomes in breast reduction surgery:
- BMI (obese or greater)
- resection of 1000g
- smoking
But what about age? So they did a study of 2156 breast reductions. They looked at the different types of reductions: inferior pedicle / Wise pattern, superior pedicle with nipple graft, vertical lift (the one I do), and liposuction alone.
What is considered a complication? They included symptomatic scars, minor wounds requiring dressings, fat necrosis, infection, and seroma.
Age groups were younger than 40, 40-50, and older than 50.
So. What did they find?
- Age over 50 is a “significant factor” impairing outcome, particularly with regard to infection and wound healing problems.
- Even 40-50 showed a trend toward complications
Why?
- They postulate due to lower estrogen levels. They found women on hormone replacement therapy or birth control pills fared better, and those with ovaries removed did worse with regard to reoperation for postoperative wounds.
- Other theories include: decreased growth factors, diminished cell proliferation.
Of note: This conflicts with a study of Roehl et al who found complications were more common in the 30-39 year old group. This paper postulates maybe the younger women in that study were different- high BMI, larger reductions- which made them get a breast reduction at a younger age. They said in this study they controlled for factors affecting the outcome, so they could single out age alone.
So take home message?
Don’t wait to do the reduction. If you are done with kids and breast feeding, and still have those hormones going, this study indicates it is better to do the surgery now.