Comparing Outcomes after Oncoplastic Breast Reduction and Breast Reduction for Benign Macromastia.

BACKGROUND: Recent studies suggest that oncoplastic breast reconstruction following partial mastectomy with concurrent symmetrizing breast reduction improves cosmetic outcomes when compared to standard breast conservation therapy alone. The authors studied whether tailoring a breast reduction to a cancer resection has an effect on complication rates by comparing (1) outcomes between oncoplastic breast reduction patients and breast reduction for benign macromastia patients and (2) complication rates between the cancer side and the symmetrizing side of an oncoplastic reduction. METHODS: A retrospective chart review was performed on female patients who underwent either oncoplastic breast reduction or bilateral breast reduction for benign macromastia between January of 2010 and October of 2018 performed by a single surgeon. Patient demographics, intraoperative data including operative approach, and postoperative outcomes were gathered from the electronic medical record and coded into a database. Specific outcomes tracked included surgical-site infection, hematoma, seroma, prolonged wound healing, nipple loss, loss of nipple sensation, fat necrosis, and revision. Chi-square and t tests were performed when appropriate to determine significance. RESULTS: Of the 211 patients included in the study, 62 (29.4 percent) underwent oncoplastic breast reduction and 149 (70.6 percent) underwent breast reduction for benign macromastia. Mean age was significantly greater in the oncoplastic group (51.9 years versus 39.8 years; p = 0.00), as were the rate of diabetes (16.4 percent versus 6.1 percent; p = 0.02) and length of anesthesia (265 minutes versus 216 minutes; p = 0.00). Total resection weight was greater in the benign group (1623 g versus 1096 g; p = 0.00). There was a higher rate of loss of nipple sensation in the oncoplastic group (chi-square, 10.6; p = 0.005) but no differences in reoperation/readmission rate, revision surgery, hematoma, seroma, surgical-site infection, or fat necrosis. There was a significantly higher complication rate in the oncologic breast when compared to the symmetrizing breast within the oncoplastic cohort (19.4 percent versus 6.5 percent; p = 0.039), but no significant differences in the rates of individual complications. CONCLUSIONS: Although the loss of nipple sensation was increased in patients undergoing oncoplastic breast reduction, all other outcomes were not significantly different between the two groups. The authors' findings indicate that oncoplastic breast reduction can be performed with a safety profile similar to that of a standard breast reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.