Wound complications following reduction mammaplasty: which patients are at risk and what can we do about it? A systematic review

Background Reduction mammoplasty is a commonly performed cosmetic procedure in the UK. Wound breakdown and infection are damaging complications both for patient experience and for cosmetic outcome. The questions we as investigators wanted to answer were: according to the best available scientific data, firstly which patients are at greatest risk of developing complications following reduction mammaplasty, and secondly what strategies are being employed by surgeons to reduce the incidence of these complications? Methods A review was carried out according to PRISMA guidelines across multiple electronic databases The key words used were a combination of “reduction”, “mammaplasty”, “mammoplasty” or “infection”. The inclusion criteria for the searches related to studies published in English, and no time-frame limit was set. Studies which specifically compared outcomes between cancer and non-cancer resections were excluded. Following review of the literature, key risk factors for the development of wound breakdown or infection following reduction mammaplasty were identified, and the available evidence for each appraised. Subsequently, methods employed by surgeons to reduce the incidence of such complications were collated, and again the evidence behind each was summarised Results Smoking status, BMI and steroid use appear to be the patient risk factors with the greatest evidence to suggest they pose an increased risk of wound complication following RM. In terms of strategies to reduce wound complications, a single dose of preoperative antibiotics appears to have a beneficial effect on wound complications and infections notably. Conclusions Reduction mammoplasty is an important plastic surgery procedure, and further research is required to understand how to minimise expensive, and cosmetically detrimental wound complications. Patient selection, counselling and risk stratification are key. Future research focussing on methods or techniques to reduce complication rates such as novel ways to protect the T junction and the utilisation of newer skin closure devices may prove valuable. Level of evidence: Not ratable