Breast reduction surgery and obesity

Numerous studies and our own large experience have shown that breast reduction surgery is very successful in relieving symptoms in a wide range of patients, regardless of their weight. However, studies have shown that obese patients (defined a Body Mass Index of 30 or more) undergoing surgery are more prone to complications at the time of surgery and during recovery.   While the overall risks of complications still remains low with breast reduction and the surgery goes very well for most patients regardless of their age, breast size or weight, we want to make you aware of these increased risks that we have noted in performing several hundred of these procedures.

Wound Healing Problems    The blood flow to the skin and breast tissue is altered by the removal of breast tissue and skin undermining during surgery. The effect of this decreased blood flow increases the risks of wound healing problems more in obese patients. While these wound healing problems are generally minor and do not require additional surgery, it may mean that there are areas along the incision lines that will require wound care (antibiotic ointment application and gauze) for several weeks. While healing is delayed the final result is usually not significantly affected.

Persistent folds on the sides and back   Many patients who are significantly obese have folds of excess skin and adipose tissue that extend from the side of the breast and wrap around the chest to the back. These cannot be removed by breast reduction surgery alone and require a more extensive procedure which is outside of the scope of the standard breast operation covered by insurance. We will do our best to minimize and improve the appearance of these folds during your breast operation but cannot eliminate them entirely.

Major complications  Major infection, bleeding, cardio-respiratory problems, blood clots, and other significant complications seem to occur more often in obese patients in some studies but we have not observed this in our practice. If we feel the  risk of these complications is too high because of other medical conditions we will not perform the surgery. The incidence of all these complications is very low making it difficult to spot any trends in our practice.

Minor complications  The appearance of scars, changes in nipple sensation, asymmetry, post operative pain, and others do not appear related to the patient’s weight at the time of surgery in our experience.

Some practices reject patients for breast reduction surgery based solely on an elevated BMI. We feel this is arbitrary and wrong and our experience proves it. We have had great success in performing breast reduction surgery on all patients regardless of weight, age and breast size and welcome the opportunity to care for these patients.