9/4/23, 21:13 Early Postoperative Complications after Oncoplastic Reduction - PMC

South Med J. Author manuscript; available in PMC 2020 Dec 29. PMCID: PMC7771341
Published in final edited form as: NIHMSID: NIHMS1653808
South Med J. 2017 Oct; 110(10): 660–666. PMID: 28973708
doi: 10.14423/SMJ.0000000000000706

Early Postoperative Complications after Oncoplastic Reduction

Anne E. Mattingly, MD, Zhenjun Ma, PhD, Paul D. Smith, MD, John V Kiluk, MD, Nazanin Khakpour, MD, Susan J.
Hoover, MD, Christine Laronga, MD, and M. Catherine Lee, MD

Abstract

Background:

Breast-conserving surgery with adjuvant radiation therapy (BCT) has been established as safe on‐
cologically. Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for
breast conservation to improve cosmetic outcomes. We evaluated the risk factors associated with
complications after oncoplastic breast reduction.

Methods:

A single-institution, institutional review board-approved, retrospective review of electronic medi‐

cal records of female patients with breast cancer who underwent oncoplastic breast reduction
from 2008 to 2014. A review of electronic medical records collected relevant medical history, clini‐
cal and pathological information, and data on postoperative complications within 6 months strati‐
fied into major or minor complications. Categorical variables analyzed with the χ2 exact method;
continuous variables were analyzed with the Wilcoxon rank sum test exact method.

Results:

We identified 59 patients; 4 required re-excision for positive margins, and 1 moved on to comple‐
tion mastectomy. The overall complication rate was 33.9% (n = 20): 12 major (20.3%) and 8 mi‐
nor (13.6%). Of the continuous variables (age, body mass index, and tissue removed), increased
age was associated with minor complications (P = 0.02). Among the categorical variables (strati‐
fied body mass index, prior breast surgery, hypertension, diabetes mellitus, hyperlipidemia, vascu‐
lar disease, pulmonary disease, and stratified weight of tissue removed), none were associated

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with overall or major complications. Pulmonary disease was associated with minor complications
(P = 0.03). Bilateral versus unilateral oncoplastic breast reduction showed no statistically signifi‐
cant increase in complications.

Conclusions:

The overall complication rate after oncoplastic breast reduction was markedly higher than that in
nationally published data for breast-conserving surgery. The complication rate resembled more
closely the complication rate after bilateral mastectomy with immediate reconstruction. No risk
factors were associated with major or overall complications. Age and pulmonary disease were as‐
sociated with minor complications. Patients should be selected and counseled appropriately when
considering oncoplastic breast reduction.

Keywords: breast-conserving surgery, breast neoplasm, breast reconstruction, mammoplasty,

postoperative complications

Surgical treatment for breast cancer has evolved during the last 30 years. Veronesi et al published
some of the first randomized studies comparing radical mastectomy with breast-conserving sur‐
gery with adjuvant radiation therapy (BCT) and demonstrated equivalent overall survival, even af‐
ter 20 years of follow-up.1 The National Surgical Adjuvant Breast and Bowel Project B-06 trial ran‐
domly assigned patients with breast cancer to mastectomy, lumpectomy alone, and lumpectomy
followed by adjuvant radiation therapy; overall survival was equivalent in all of the treatment
groups.2 At 20 years follow-up, the recurrence rate was 14.3% in the lumpectomy with radiation
cohort compared with 39.2% in the lumpectomy alone cohort, and the benefit of radiation was in‐
dependent of nodal status. Disease-free survival and overall survival were again equivalent in all
of the treatment groups.2 Radiation therapy was associated with a marginally decreased risk of
death from breast cancer, although deaths from other causes offset this finding.2 In 1990, the
National Institutes of Health developed a consensus statement on the treatment of early-stage
breast cancer that favored BCT over mastectomy.3 Subsequently, the American College of
Radiology released appropriateness criteria for BCT, which state that most early-stage breast can‐
cer can be treated with lumpectomy followed by whole-breast irradiation at a dose of 45 to 50.4
Gy in 1.8 to 2 Gy fractions in 4.5 to 5.5 weeks.4

Because BCT, which encompasses lumpectomy with negative margins and adjuvant radiation, has
been established as safe oncologically, there has been an increased interest in improving aesthetic
outcomes. The 2014 American Society for Radiation Oncology (ASTRO) Consensus Guidelines de‐
fine negative margin as no invasive carcinoma on ink.5 Positive margins are associated with a dou‐
bled risk of ipsilateral breast tumor recurrence compared with negative margins, regardless of tu‐
mor biology or radiation boost; however, wider margins do not decrease recurrence.5 Poor aes‐
thetic outcome after BCT has been reported to be as high as 6.5%, with 29% reporting an inter‐
mediate aesthetic outcome.6 Independent predictors of poor aesthetic outcomes include tumor
position in the inner half of the breast, tumor behind the nipple areolar complex, quadrantectomy,
and tumors ≥5 cm.6 Other predictors include high tumor volume-to-breast volume ratio.7

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Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for breast conser‐
vation to improve aesthetic outcomes. Oncoplastic breast surgery can be a broad term encom‐
passing many surgical techniques.8 We focused on the breast volume displacement technique of
oncoplastic breast reduction, or reduction mammoplasty, which uses a pedicled flap, depending
on tumor location, allowing large-specimen excision.8 This often is used for women with larger
breasts who desire a smaller breast size, and the contralateral breast often is concurrently re‐
duced to improve symmetry (Fig.). Oncoplastic breast surgery allows for breast conservation with
improved cosmesis in situations in which a larger specimen removal traditionally would produce a
significant cosmetic deformity.

Fig.

Preoperative, immediately postoperative, and 1-year postoperative photographs of bilateral oncoplastic

reduction.

A systematic review of the literature for oncoplastic breast surgery evaluated oncologic and aes‐
thetic outcomes. Close margins were noted in 3% to 13% and positive margins in 0% to 10% of
published studies. Overall, despite the larger volume of resection, this did not guarantee a negative
surgical margin.8 Local recurrence at 24-month follow-up was 0% to 7%, similar to data published
on standard BCT, and approximately 3% to 16% of patients required conversion to mastectomy.8
Good aesthetic outcomes were noted in 84% to 89% of patients, although the manner of assess‐
ment varied widely among studies; quality of life at 12 months postoncoplastic breast surgery was
significantly higher than standard BCT. Compared with the 60% to 80% acceptable aesthetic out‐
comes after BCT, 94% of patients undergoing oncoplastic breast surgery were satisfied or ex‐
tremely satisfied, although this rate was much lower when >20% of breast volume was removed.8
A published comparison of long-term aesthetic outcomes alter oncoplastic breast surgery versus
BCT showed that excellent aesthetic results were achieved more frequently in oncoplastic breast
surgery.9 Of note, this study suggested that being 70 years or older; having tumors in the medial,
inferior, and central quadrants; and having large breasts were significant risk factors for poor aes‐
thetic outcomes after BCT.9

Published National Surgical Quality Improvement Program (NSQIP) data on early postoperative
complications for BCT compared with simple mastectomy with implant reconstruction showed
that the mastectomy with implant group had significantly higher total complications (5.5%) com‐
pared with BCT (2.1%), despite a significantly higher rate of preexisting risk factors among the
BCT group.10 Another NSQIP analysis evaluating perioperative complications in immediate breast
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reconstruction showed that bilateral mastectomy was associated with a longer hospitalization and
higher transfusion rates than unilateral mastectomy; however, surgical site complications and
medical complications were similar between patients who underwent unilateral and bilateral
mastectomy.11 Similar to bilateral mastectomy, oncoplastic breast surgery often includes contralat‐
eral reduction mammoplasty for symmetry, which theoretically could increase wound complica‐
tions by doubling the surgical sites. NSQIP data estimate early postoperative complications for bi‐
lateral mastectomy to be approximately 21.2% and 14.7% for unilateral mastectomy.11 As the lit‐
erature continues to evaluate oncologic and long-term aesthetic outcomes in oncoplastic breast
surgery, we sought to evaluate the risk factors associated with postoperative complications within
the first 6 months after oncoplastic breast reduction.

Methods

A single-institution, institutional review board-approved, retrospective study reviewed electronic

medical records (EMRs) of female patients with breast cancer who underwent breast conserva‐
tion with concomitant oncoplastic breast reduction from 2008 to 2014. All of the patients were
undergoing breast-conserving surgery for breast cancer at the time of the breast reduction.
Patients were identified by operative schedules for five breast surgical oncologists practicing at an
National Cancer Institute–designated Comprehensive Cancer Center; every patient with a diagno‐
sis of breast cancer, ductal carcinoma in situ, or a breast mass scheduled for surgery with terms
including oncoplastic reduction, reduction mammoplasty, or breast reduction was included in
medical record interrogation.

All of the patients were treated by a fellowship-trained breast surgical oncologist, with the major‐
ity performed in conjunction with a board-eligible or board-certified plastic surgeon; all of the
cases involving concurrent reduction of an unaffected breast were performed by a plastic sur‐
geon. Each patient underwent evaluation of medical comorbidities and standard preoperative as‐
sessment by anesthesia before proceeding with the planned surgery.

EMR review collected historical information including medical history, age, body mass index (BMI),
prior breast surgery, and family history. The clinical and pathologic information collected included
preoperative imaging findings, surgical pathology, weight of breast tissue removed, receptor sta‐
tus, margin status, and need for reexcision. Further treatment data encompassed postoperative
complications, placement of clips to mark the lumpectomy cavity for radiation planning, and fat
necrosis noted on follow-up imaging. Complications within the first 6 months of surgery noted in
the EMR were stratified into major or minor. Major complications required a procedure or hospi‐
talization. Examples include seroma or hematoma requiring aspiration/percutaneous drain place‐
ment, operative debridement, or cosmesis requiring operative revision. Minor complications in‐
cluded all others (eg, minor wound breakdown, mild asymmetry not requiring revision).

Historical variables were separated into categorical and continuous variables for analysis.
Categorical variables included prior breast surgery, hypertension, diabetes mellitus, hyperlipi‐
demia, vascular disease (including coronary or peripheral vascular disease), pulmonary disease
(including obstructive sleep apnea and chronic obstructive pulmonary disease), and procedure
(bilateral, unilateral). We also included stratified BMI (<25, 25–29, ≥30) and the stratified weight
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of breast tissue removed (<500 g, 500–1000 g, >1000 g) as categorical variables. Categorical vari‐
ables were analyzed using the χ2 exact method. Continuous variables included age, BMI, and
weight of breast tissue removed, which were analyzed with the Wilcoxon rank sum test exact
method. The weight of tissue removed was classified by ipsilateral breast (primary cancer site)
and contralateral breast. Contralateral breast procedures were most often benign procedures
performed for symmetry.

Results

A total of 59 patients were identified. The average age was 55.6 years (median 56, range 25–75)
and the average BMI was 32 (median 34.1, range 21–57). Preoperative imaging was assessed for
the largest extent of disease and the closest distance from the nipple on any modality. Average ex‐
tent of disease was 3.3 cm (median 3.0, range 0.4–12.0), and average distance from the nipple was
6.5 cm (median 7.0, range 0.4–12.0). For patients with bilateral pathology (n = 4), each side was
considered separately in assessment of preoperative imaging; a plastic surgeon was involved in
the oncoplastic procedure of 54 of 59 (91.5%) patients.

Table 1 summarizes the clinical and pathologic features. The most common comorbidity was obe‐
sity, with 66.1% of patients classified as obese (BMI ≥30), 28.8% as overweight (BMI 25–29), and
only 5.1% with normal BMI (≤24). BMI was calculated from preoperative measurements of height
and weight. Hypertension (44.1%) and hyperlipidemia (25.4%) also were frequently noted. The
average specimen weight in grams was 782.9 (median 603.7, range 39.8–2617.0). Of note, some
procedures did include additional smaller specimens that were not weighed but may have in‐
creased total volume of tissue removed. Of the 59 patients, 8 had unilateral oncoplastic reduction,
whereas 51 had oncoplastic breast reduction with simultaneous contralateral reduction mammo‐
plasty. One of the unilateral patients eventually underwent have planned contralateral reduction
mammoplasty, but >12 months after initial surgery. This patient was included in the unilateral
group to assess early postoperative complications.

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Table 1.

Summary of clinical and pathologic features

N %

Comorbidities, n = 59

BMI

<25 3 5.1

25–29 17 28.8

≥30 39 66.1

Prior breast surgery 11 18.6

Hypertension 26 44.1

Diabetes mellitus 6 10.2

Hyperlipidemia 15 25.4

Vascular disease 2 3.4

Pulmonary disease 2 3.4

a
ASA score

1 1 1.7

2 46 78.0

3 12 20.3

Procedures, n = 59

Unilateral 8 13.6

Bilateral 51 86.4

Delayed contralateral 1 1.7

Reexcision 4 6.8

Completion mastectomy 1 1.7

Histology, n = 60

Ductal carcinoma in situ 11 18.3

Invasive ductal carcinoma 33 55.0

Invasive lobular carcinoma 10 16.7

Benign phyllodes 4 6.8

Other 2 3.4

Receptor status, n = 60

Estrogen receptor positive 48 80.0

ASA, American Society of Anesthesiologists; BMI, body mass index; HER2, human epidermal growth factor recep‐
tor 2; N/A, not applicable.

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a
American Society of Anesthesiologists classification.

Reexcision for positive margins after oncoplastic breast reduction was required in 6.8% (n = 4) of
patients, and 1.7% required completion mastectomy (n = 1). One patient had bilateral invasive dis‐
ease with unilateral invasive ductal carcinoma and contralateral invasive lobular carcinoma tallied
separately. For this patient, receptors, margins, clips for radiation therapy, and completion of radi‐
ation therapy were tallied for each invasive cancer. On follow-up 11 patients (18.6%) were noted
to have an abnormality on imaging or examination that was confirmed pathologically to be fat
necrosis. Table 2 summarizes the early postoperative complications, both major and minor, after
oncoplastic reduction. Twenty patients (33.9%) experienced a complication: 12 major (20.3%)
and 8 minor (13.6%). The most common complication overall was seroma or hematoma requiring
aspiration (6.7%) followed by asymmetry requiring revision (5.1%). For the patients who under‐
went unilateral oncoplastic breast reduction (n = 8), 2 patients experienced a complication; 1 pa‐
tient experienced minor asymmetry, and 1 patient had an abscess that required incision and
drainage. For unilateral procedures the overall complication rate was 25.0%. The remaining com‐
plications (n = 18) were in patients who underwent bilateral oncoplastic breast reduction (n =
51). For bilateral oncoplastic breast reduction, the overall complication rate was 35.3%.

Table 2.

Summary of early postoperative complications, n = 59

N %

Total complications 20 33.9

Major complications 12 20.3

Abscess requiring incision and drainage 1 1.7

Hematoma/seroma requiring aspiration 4 6.7

Seroma requiring drain placement 1 1.7

Wound breakdown requiring operative debridement 2 3.4

Asymmetry requiring revision 3 5.1

Stroke requiring hospitalization 1 1.7

Minor complications 8 13.6

Mild asymmetry without revision 2 3.4

Nipple necrosis, minor 1 1.7

Wound breakdown requiring follow-up 2 3.4

Lymphedema, arm 1 1.7

Breast lymphedema/erythema requiring antibiotics 1 1.7

Mild wound breakdown requiring debridement in clinic 1 1.7

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For each variable, patients without complications were compared (n = 39) with those with any
complications (n = 20), those with major complications (n = 12), and those with minor complica‐
tions (n = 8). For the purposes of analysis, specimen weight was classified as ipsilateral (cancer
site) and contralateral (benign) for patients who had bilateral procedures. If a patient had bilat‐
eral cancer (n = 4), then each cancer had an ipsilateral and contralateral specimen weight that was
included in analysis because this variable was considered a breast-specific risk factor.

Among breast-specific risk factors (specimen weight, prior breast surgery, and type of procedure)
no variable approached statistical significance (Table 3). Table 4 summarizes patient-specific risk
factors: age, BMI, stratified BMI, hypertension, diabetes mellitus, hyperlipidemia, vascular disease,
and pulmonary disease. Increased age was significantly associated with minor complications (P =
0.02) but not with overall complications (P = 0.12). None were associated with overall or major
complications. Pulmonary disease (including emphysema and obstructive sleep apnea) was associ‐
ated with minor complications (P = 0.03) but not with complications overall (P = 0.11). No other
categorical variables reached statistical significance. Diabetes mellitus trended toward an associa‐
tion with major complications (P = 0.13) but, again, not with minor (P = 0.64) or overall complica‐
tions P = 0.66). Complications (major and minor) were evenly split between cancer-affected breast
and unaffected breast procedures.

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Table 3.

Univariate analysis of breast-specific risk factors for complications after oncoplastic breast reduction

Complications

None, N = 42 Any, N = 21 Major, N = 12 Minor, N = 9

Mean Mean P Mean P Mean P

Ipsilateral specimen weight, g 831 738 0.95 678 0.88 832 0.94

Contralateral specimen weight, g 914 770 0.28 746 0.37 809 0.44

n n P n P n P

Prior breast surgery 11 4 1.00 2 1.00 2 1.00

Ipsilateral specimen weight, g

<500 14 7 0.48 4 0.24 3 1.00

500–1000 12 8 6 2

>1000 12 3 1 2

Contralateral specimen weight, g

<500 8 8 0.27 4 0.41 4 0.25

500–1000 14 6 5 1

>1000 13 4 2 2

Procedure

Bilateral 51 18 0.72 11 0.70 7 1.00

Unilateral 8 2 1 1

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Table 4.

Univariate analysis of patient-specific risk factors for complications after oncoplastic breast reduction

Complications

No, N = 39 Any, N = 20 Major, N = 12 Minor, N = 8

Mean Mean P Mean P Mean P

BMI 33.2 35.9 0.30 36.3 0.35 35.3 0.52

Age, y 54 58.7 0.12 55.5 0.74 63.4 0.02

n n P n P n P

BMI

<25 3 0 0.43 0 0.68 0 0.69

25-29 10 7 4 3

≥30 26 13 8 5

Hypertension 18 8 0.79 3 0.32 5 0.46

Diabetes mellitus 3 3 0.66 3 0.13 0 0.64

Hyperlipidemia 11 4 0.55 1 0.26 3 0.69

Vascular disease 1 1 1.00 1 0.42 0 1.00

Pulmonary disease 0 2 0.11 0 0.42 2 0.03 a

BMI, body mass index.

a
Statistically significant.

Discussion

Because BCT has been established as safe oncologically,1,2 studies have noted concerns regarding
aesthetic outcomes in these patients.6,7 Oncoplastic breast surgery reportedly has aesthetic out‐
comes ranging between 84% and 89%, an improvement of >60% to 80% for BCT.8 The American
Society of Breast Surgeons (ASBS) released a consensus in 2015 regarding tools to improve reop‐
erations and improve aesthetic outcomes in breast cancer,12 noting oncoplastic techniques as hav‐
ing the potential to reduce positive margins and allow larger volume resections while improving
the appearance of the breasts. The ASBS encourages appropriate patient selection and clip place‐
ment for radiation planning.12 Few publications, however, evaluate the complication rates associ‐
ated with these procedures. We did examine our data compared with other published series and
national databases in interpreting our results.

In our series, 20 patients (33.9%) experienced an early postoperative complication, with 12 being
major complications (20.3%). Of categorical variables, only pulmonary disease was significantly
associated with minor complications (P = 0.03). Two of these patients had other risk factors, in‐
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cluding hypertension, increased age, and elevated BMI. This likely is only a marker of general med‐
ical morbidity for these patients, putting them into a broader risk category of complications for
any procedure. Of the continuous variables, age was associated with minor complications (P =
0.02).

Our study is limited in its retrospective design, small dataset, and lack of benign case-control co‐
hort. Two other small singleinstitution retrospective series also have suggested major complica‐
tion rates of approximately 22% among oncoplastic reduction cases, which is similar to our
findings.13,14

Reexcision rates after lumpectomy based on NSQIP data were twice as high (13.2%)15 compared
with our reexcision after oncoplastic breast reduction (6.8%), lending some support to the poten‐
tial improvement in positive margins with oncoplastic breast surgery. Decreasing reexcisions may
improve operative complications; however, our data suggest that complications are much higher
after oncoplastic breast reduction than in the national data for breast-conserving surgery, even if
decreased reexcisions are incorporated into the estimate. Although the ASBS consensus recom‐
mended considering clip placement, clips were placed in only 60% of patients in this series be‐
cause of unreliable clip positioning after tissue rearrangement, making the clips useless for radia‐
tion therapy boost planning.

Just as important as this significant association was the lack of association with other variables. A
previously published NSQIP analysis of BCT and mastectomy showed diabetes mellitus, smoking
status, and an American Society of Anesthesiologists (ASA) score of 3 or 4 were significant predic‐
tors of postoperative complications.10 ASA score also is likely a marker of medical morbidity, simi‐
lar to our patients identified as having pulmonary disease. Among the patients with pulmonary co‐
morbidities, ASA scores were 2 and 3, respectively. For the group overall, the majority (78%) were
ASA 2 (n = 46). In this series, pulmonary disease (n = 2) was never in isolation, and both patients
had chronic obstructive pulmonary disease, hypertension, and elevated BMI. BMI and diabetes
mellitus were not significantly associated with any complications, although diabetes mellitus did
trend toward an association with minor complications (P = 0.13). We did not have hemoglobin
A1c values, which may have been useful to separate complications in well-controlled versus
poorly controlled patients with diabetes mellitus.

It is difficult to compare our patient population with patients undergoing elective breast reduction.
Previously published retrospective data comparing reduction mammoplasty for breast cancer ver‐
sus macromastia showed that patients with benign tumors were generally younger (mean 42.3
years vs 57.5 years) with lower BMIs (mean 26.1 vs 20.6).14 In this prior study the oncoplastic
breast reduction group did not have increased perioperative complications compared with the be‐
nign group, although BMI was a significant predictor of complications for either group.14 Our on‐
coplastic breast reduction group was similar to the previously published group, with an average
age of 55.6 years (median 56, range 25–75); we noted a higher BMI with a mean of 32 (median
34.1, range 21–57). We were unable to demonstrate an increase in complications with increasing
BMI, however. This is likely the result of using the small dataset and that the majority of our pa‐

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tients had an abnormal BMI; only 5.1% (n = 3) had a normal BMI. Nevertheless, without a control
group, we cannot definitively demonstrate a higher BMI compared with patients with benign
tumors.

Complications of contralateral prophylactic mastectomy have gained increased attention in the

media. An NSQIP analysis reported a 14.7% overall complication rate with unilateral mastectomy
versus 21.2% after bilateral mastectomy (P < 0.001).11 As expected, with the doubling of surgical
wounds, wound disruption was higher in the bilateral mastectomy (1.6%) compared with the uni‐
lateral mastectomy (0.7%) group (P = 0.015).11 Similarly, BCT is limited to one breast, whereas on‐
coplastic breast reduction often involves bilateral breasts because of contralateral reduction mam‐
moplasty for symmetry. Among unilateral oncoplastic breast reduction patients (n = 8), the com‐
plication rate was 25.0% (n = 2) compared with bilateral oncoplastic breast reduction (n = 51),
which had a complication rate of 35.3% (n = 18). Directly comparing unilateral to bilateral in our
data, we did not find a significant increase in overall complications (P = 0.71), major complications
(P = 0.69), or minor complications (P = 1.0). This occurred likely because of the small number of
patients or because the majority (86%) underwent bilateral procedures, thereby limiting the data
available to compare unilateral and bilateral procedures. We did, however, note a significantly
higher complication rate in oncoplastic breast reduction rates compared with nationally reported
BCT complication rates.10 Our complication rate more closely resembled NSQIP data for early
postoperative complications after bilateral mastectomy with immediate reconstruction. It is impor‐
tant to note that there are significant differences between the populations that limit comparisons;
in particular, a majority of patients who underwent bilateral mastectomy/immediate reconstruc‐
tion had a BMI <30 (73%), whereas a majority of our population had a BMI ≥30 (66%).11

As such, when counseling patients considering oncoplastic breast reduction, the discussion should
include the potential for increased early postoperative complications with oncoplastic breast re‐
duction compared with BCT and the similar risk of major complications between oncoplastic
breast reduction and bilateral mastectomy with reconstruction. The benefit of improved long-term
aesthetic outcomes for oncoplastic breast reduction over BCT8,9 documented in the literature is
worth noting, as well as the psychological benefit, especially as it relates to the quality of life and
body image11,16 that breast conservation affords women who may otherwise require mastectomy
because of tumor size and location.

Conclusions

The overall complication rate after oncoplastic breast reduction is markedly higher than nationally
published data for BCT. The complication rate more closely resembles postoperative complications
after bilateral mastectomy with immediate reconstruction. None of the variables analyzed, includ‐
ing BMI and diabetes mellitus, were associated with major or overall complications. Age and pul‐
monary disease were risk factors that were associated with minor complications after oncoplastic
breast reduction. Candidates for oncoplastic breast reduction should be selected carefully and
counseled appropriately about the potential for increased early postoperative complications when
considering bilateral oncoplastic breast reduction.

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Key Points

The overall complication rate after oncoplastic breast reduction is markedly higher
than that in nationally published data for breast-conserving surgery with adjuvant
radiation therapy.
No variables analyzed, including body mass index and diabetes mellitus, were
associated with major or overall complications.
Age and pulmonary disease were risk factors associated with minor complications
after oncoplastic breast reduction.
Candidates for oncoplastic breast reduction should be selected carefully and counseled
appropriately about the potential for increased early postoperative complications
when considering bilateral oncoplastic breast reduction versus breast-conserving
surgery with adjuvant radiation therapy.

Acknowledgments

The authors thank Jiannong Li, statistician, and Coordinator of Research, Graduate Medical
Education, Angela Reagan for their assistance in the data analysis and manuscript preparation.

Footnotes

M.C.L. has received compensation from Up-To-Date and Genomic Health. The remaining authors did not report any fi-
nancial relationships or conflicts of interest.

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