Complications following breast reduction surgery more common in older women

Complications following breast reduction surgery—particularly infections—are more common in women older than 50, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The increased complication rate in older women likely reflects age-related changes in hormone levels, according to the new research by Dr. Michele A. Shermak and colleagues of The Johns Hopkins Medical Institutions, Baltimore.

Over Age 50, More Problems after Breast Reduction

The researchers evaluated 1,192 women undergoing breast reduction surgery from 1999 to 2009. The researchers assessed rates and types of complications in three different age groups: under 40, 40 to 50, and over 50.

Breast reduction surgery—also called reduction mammaplasty—is among the most commonly performed breast plastic surgery procedures. It is highly effective in relieving symptoms related to overlarge breasts, such as back, shoulder and neck pain, posture problems and bra strap compression.

The results suggest that women over 50 are at higher risk of developing an infection after breast reduction surgery. On analysis controlling for other medical conditions, the infection rate was 2.7 times higher for women over 50, compared to the under-40 group.

Women over 50 also tended to have a higher rate of wound healing problems, leading to a higher rate of repeat surgery to remove areas of dead skin, called debridement. These trends were not statistically significant, however.

Women ages 40 to 50 also showed a nonsignificant trend toward an increased risk of infection. Other important types of complications were unaffected by age.

Declining Hormone Levels May Contribute to Risk

Previous studies have identified several risk factors for complications after breast reduction surgery, including obesity, extensive breast reduction, and smoking. However, the new study is the first to focus specifically on age.

The results suggest an increased rate of infections—and possibly other complications—after breast reduction surgery in women over 50. The increased risk is likely related to age-related declines in hormone levels, Dr. Shermak and colleagues believe. This is borne out by the trend toward increased infections among women in their forties, when hormone levels start to decline.

In addition, infections tended to be less common in women who were using hormone replacement therapy. Meanwhile, the infection rate appeared higher in women who had undergone hysterectomy or oophorectomy (removal of the ovaries), which lead to sharp drops in hormone levels.

The new results suggest that age may act as a "confounding factor" in assessing the risk of complications after breast reduction surgery—especially in women over 50. Hormonal status may warrant special attention, Dr Shermak and coauthors believe.

The researchers suggest that plastic surgeons should ask women considering breast reduction about any factors potentially related to hormonal deficiency, including a history of hysterectomy and/or oophorectomy. They also suggest that "hormone replacement therapy may be worth considering in this group of patients."