A Retrospective Study of Factors Affecting Preoperative BMI in Patients Undergoing Reduction Mammoplasty

Abstract

Introduction:

Reduction mammoplasty (RM) is a common plastic surgery procedure; it can significantly improve patients’ quality of life. However, some women with macromastia are extremely obese, increasing their risk of postoperative complications. At our institution, patients’ body mass index (BMI) must be less than 35 to be considered for the procedure. Therefore, many women fail to qualify for this elective surgery at initial screenings. This study is to determine how many patients failed to meet the BMI requirement initially, and how many of them could achieve the required lose weight and receive the procedure. Importantly, we examined the factors associated with successful weight reductions.

Methods:

With institutional review board approval, we reviewed the records of all consultations for RM in 2019 by a single academic plastic surgery unit. The outcome variables extracted were initial BMI, BMI at time of RM, and frequency and factors associated with achieving BMI of 35 or less. In addition to logistic regressions, we performed Fisher exact tests for categorical variables and t-test for continuous variables. Multicollinearity test was done to assure independence as was Bonferroni correction for multiple variables.

Results:

Fifty-two (52%) women who had a consultation for an RM had a BMI >35. The weight loss recommendation by the plastic surgeon remained constant during the study period and consisted of bariatric surgery consults, nutrition consults, and diet modification. Even though bariatric surgery referral was the most common recommendation (26, 50% of all patients), only 1 patient underwent bariatric surgery. The 3 key elements for diet modification were to improve the quantity and quality of food intake reducing total calorie to 1800 to 2000 Cal per day, multivitamin supplements, and intermittent fasting for longer than 12 hours to induce oxidation of fatty acid stores. Only 7 (14%) of women in this study were able to lose weight and undergo RM. These women had mild BMI excess and were significantly more likely to visit their primary care physician (P = .0059) and adhere to the diet modifications and exercise (P = .0049). Patients who did not receive RM had a significantly greater mean weight at 112.3 kg (14.1) compared with 102.5 kg (10.8) (P = .0081).

Conclusion:

This study showed that only a small fraction of the obese patients seeking RM lost weight with preoperative counseling. The single most important factor associated with successful decrease in BMI to below 35 was starting BMI not to exceed 40.