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Breast Reduction Surgery Has Higher Complication Rate in Older Women

More Problems with Infections and Healing in Women Over 50

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." 

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of  Wolters Kluwer Health
About Plastic and Reconstructive Surgery
For more than 60 years,  Plastic and Reconstructive Surgery® ( has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons,  Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues. 

About ASPS
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. For more information, please visit
About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the  LWW brand, as well as content-based sites and online corporate and customer services. 

LWW is part of  Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of  Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).