Prehabilitation for Patients Undergoing Breast Reduction Surgery: A Scoping Review.

Abstract

Background: Reduction mammoplasty (RM) is one of the most common plastic surgery procedures, with close to 76,000 performed annually. Between 14% and 53% of patients may experience a complication after RM. Medically optimizing patients preoperatively is essential to mitigate these risks and provide the best surgical outcome. This scoping review aims to identify the efficacy of prehabilitation for cosmetic RM and identify mutable patient characteristics that could reasonably be targeted with prehabilitation to improve surgical outcomes.

Methods: A comprehensive PubMed review was performed in April 2025 to identify cosmetic RM-related articles that discussed risks associated with mutable patient characteristics and outcomes following prehabilitation. Data collected included article type, topic, participant information, and study outcome.

Results: A total of 123 articles met inclusion criteria. Most articles addressed the effects of body mass index (n = 61, 50%), age (n = 55, 45%), or mental health (n = 19, 15%). High-risk mutable characteristics identified included obesity, malnourishment, frailty, diabetes, smoking, poverty, cardiovascular and hematologic issues, vitamin D deficiency, history of bariatric surgery, and chronic steroid use. Only 1 article directly reported the effects of prehabilitation regimens on RM outcomes, showing that a weight loss intervention reduced complications.

Conclusions: Although RM prehabilitation with a focus on weight loss demonstrated quantifiable improvement in surgical outcomes, prehabilitation programs for other mutable characteristics have not been directly studied. However, risk-increasing characteristics should be optimized before surgery. Further evidence is needed to provide quantifiable data on the effectiveness of prehabilitation.