Jane N Ewing, Ellen F Niu, Chris Amro, Zachary Gala, Mehdi S Lemdani, Ashley E Chang, Robyn B Broach, Joseph M Serletti, John P Fischer
{"title":"平衡天平:针对肥胖 III 级患者的乳房缩小整形手术建议需谨慎。","authors":"Jane N Ewing, Ellen F Niu, Chris Amro, Zachary Gala, Mehdi S Lemdani, Ashley E Chang, Robyn B Broach, Joseph M Serletti, John P Fischer","doi":"10.1097/SAP.0000000000004010","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of obesity has risen worldwide, posing a problem to surgeons as obesity is a well-known risk factor for surgical outcomes. While prior studies have suggested performing reduction mammaplasty (RM) in patients with obesity, the variance in outcomes and quality of life (QoL) for obesity classes are ill-defined. We investigated whether obesity classes should be considered for RM by examining the surgical outcomes and QoL across different weight classes, aiming to pinpoint when outcomes become less favorable.</p><p><strong>Methods: </strong>Patients undergoing RM by nine surgeons from 2016 to 2022 were included. Body mass index (BMI) cohorts were formed according to the Center for Disease Control and Prevention (CDC) guidelines: Healthy (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obesity class I (30-34.9 kg/m 2 ), II (35-39.9 kg/m 2 ), and III (>40 kg/m 2 ). QoL was assessed by comparing preoperative and postoperative BREAST-Q scores within cohorts. A comparison analysis was performed between weight classes.</p><p><strong>Results: </strong>A total of 461 RM patients were identified (healthy: 83, overweight: 178, I: 142, II: 39, III: 19). Percentage of Black patients, procedure length, weight of tissue removed, and inferior pedicle technique all significantly increased as BMI increased ( P < 0.001). Higher BMI cohorts, especially class III, had significantly higher rates of surgical site infections (healthy: 0%, overweight: 1.1%, I: 1.4%, II: 0%, III: 15.8%, P < 0.01), fat necrosis (healthy: 1.2%, overweight: 5.1%, I: 7%, II: 0%, III: 22.2%, P = 0.01), dehiscence (healthy: 3.6%, overweight: 2.8%, I: 2.1%, II: 5.1%, III: 31.6%, P < 0.01), delayed healing (health: 4.8%, overweight: 11.2%, I: 16.9%, II: 28.2%, III: 42.1%, P < 0.01), minor T-point breakdown (healthy: 10.8%, overweight: 15.7%, I: 23.9%, II: 23.1%, III: 52.6%, P = 0.01), and surgical site occurrence requiring procedural intervention (healthy: 6.0%, overweight: 5.6%, I: 6.3%, II: 15.4%, III: 21.1%, P < 0.05). When compared to the other weight classes independently, class III was associated with unfavorable outcomes ( P < 0.05). Significant improvement in average postoperative QoL scores in satisfaction with breast, psychosocial well-being, sexual well-being, and physical well-being were seen in all cohorts except class III ( P < 0.05).</p><p><strong>Conclusions: </strong>Severe obesity class III patients undergoing RM have a higher yet still acceptable risk profile and should be counseled on the risks despite its improved quality of life.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Balancing the Scales: Caution in Reduction Mammaplasty Recommendations for Obesity Class III Patients.\",\"authors\":\"Jane N Ewing, Ellen F Niu, Chris Amro, Zachary Gala, Mehdi S Lemdani, Ashley E Chang, Robyn B Broach, Joseph M Serletti, John P Fischer\",\"doi\":\"10.1097/SAP.0000000000004010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The prevalence of obesity has risen worldwide, posing a problem to surgeons as obesity is a well-known risk factor for surgical outcomes. While prior studies have suggested performing reduction mammaplasty (RM) in patients with obesity, the variance in outcomes and quality of life (QoL) for obesity classes are ill-defined. We investigated whether obesity classes should be considered for RM by examining the surgical outcomes and QoL across different weight classes, aiming to pinpoint when outcomes become less favorable.</p><p><strong>Methods: </strong>Patients undergoing RM by nine surgeons from 2016 to 2022 were included. Body mass index (BMI) cohorts were formed according to the Center for Disease Control and Prevention (CDC) guidelines: Healthy (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obesity class I (30-34.9 kg/m 2 ), II (35-39.9 kg/m 2 ), and III (>40 kg/m 2 ). QoL was assessed by comparing preoperative and postoperative BREAST-Q scores within cohorts. A comparison analysis was performed between weight classes.</p><p><strong>Results: </strong>A total of 461 RM patients were identified (healthy: 83, overweight: 178, I: 142, II: 39, III: 19). Percentage of Black patients, procedure length, weight of tissue removed, and inferior pedicle technique all significantly increased as BMI increased ( P < 0.001). Higher BMI cohorts, especially class III, had significantly higher rates of surgical site infections (healthy: 0%, overweight: 1.1%, I: 1.4%, II: 0%, III: 15.8%, P < 0.01), fat necrosis (healthy: 1.2%, overweight: 5.1%, I: 7%, II: 0%, III: 22.2%, P = 0.01), dehiscence (healthy: 3.6%, overweight: 2.8%, I: 2.1%, II: 5.1%, III: 31.6%, P < 0.01), delayed healing (health: 4.8%, overweight: 11.2%, I: 16.9%, II: 28.2%, III: 42.1%, P < 0.01), minor T-point breakdown (healthy: 10.8%, overweight: 15.7%, I: 23.9%, II: 23.1%, III: 52.6%, P = 0.01), and surgical site occurrence requiring procedural intervention (healthy: 6.0%, overweight: 5.6%, I: 6.3%, II: 15.4%, III: 21.1%, P < 0.05). When compared to the other weight classes independently, class III was associated with unfavorable outcomes ( P < 0.05). 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引用次数: 0
摘要
简介:肥胖症的发病率在全球范围内不断上升,这给外科医生带来了难题,因为众所周知,肥胖症是影响手术效果的一个风险因素。虽然之前的研究建议对肥胖症患者实施乳房缩小整形术(RM),但肥胖等级在手术效果和生活质量(QoL)方面的差异尚不明确。我们通过研究不同体重等级患者的手术效果和 QoL,调查了是否应考虑对肥胖等级患者进行乳房缩小术,旨在确定何时手术效果会变得较差:纳入了2016年至2022年期间由9名外科医生进行RM手术的患者。根据美国疾病控制和预防中心(CDC)的指南,建立了体重指数(BMI)队列:健康(18.5-24.9 kg/m2)、超重(25-29.9 kg/m2)、肥胖 I 级(30-34.9 kg/m2)、II 级(35-39.9 kg/m2)和 III 级(>40 kg/m2)。通过比较组群内术前和术后的 BREAST-Q 评分来评估 QoL。结果:结果:共确定了 461 名 RM 患者(健康:83 人;超重:178 人;I 型:142 人;II 型:39 人;III 型:19 人)。黑人患者的比例、手术时间、切除组织的重量和下椎弓根技术都随着体重指数的增加而显著增加(P < 0.001)。BMI 较高的组群,尤其是 III 级,手术部位感染(健康:0%,超重:1.1%,I:1.4%,II:0%,III:15.8%,P <0.01)、脂肪坏死(健康:1.2%,超重:5.1%,I:7%,II:0%,III:22.2%,P = 0.01)、开裂(健康:3.6%,超重:2.8%,I:2.1%,II:5.1%,III:31.6%,P <0.01)、延迟愈合(健康:4.8%,超重:11.2%,I:16.9%,II:28.2%,III:42.1%,P <0.01)、轻微 T 点破裂(健康:10.8%,超重:15.8%,I:16.9%,II:28.2%,III:42.1%,P <0.01):10.8%,超重:15.7%,I:23.9%,II:23.1%,III:52.6%,P = 0.01),以及需要手术干预的手术部位发生率(健康:6.0%,超重:5.6%,I:6.3%,II:15.4%,III:21.1%,P < 0.05)。与其他体重等级相比,III 级患者的预后较差(P < 0.05)。除 III 级患者外,所有组别患者术后在乳房满意度、社会心理健康、性健康和身体健康方面的平均 QoL 评分均有显著改善(P < 0.05):结论:接受 RM 手术的 III 级重度肥胖患者的风险较高,但仍可接受。
Balancing the Scales: Caution in Reduction Mammaplasty Recommendations for Obesity Class III Patients.
Introduction: The prevalence of obesity has risen worldwide, posing a problem to surgeons as obesity is a well-known risk factor for surgical outcomes. While prior studies have suggested performing reduction mammaplasty (RM) in patients with obesity, the variance in outcomes and quality of life (QoL) for obesity classes are ill-defined. We investigated whether obesity classes should be considered for RM by examining the surgical outcomes and QoL across different weight classes, aiming to pinpoint when outcomes become less favorable.
Methods: Patients undergoing RM by nine surgeons from 2016 to 2022 were included. Body mass index (BMI) cohorts were formed according to the Center for Disease Control and Prevention (CDC) guidelines: Healthy (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obesity class I (30-34.9 kg/m 2 ), II (35-39.9 kg/m 2 ), and III (>40 kg/m 2 ). QoL was assessed by comparing preoperative and postoperative BREAST-Q scores within cohorts. A comparison analysis was performed between weight classes.
Results: A total of 461 RM patients were identified (healthy: 83, overweight: 178, I: 142, II: 39, III: 19). Percentage of Black patients, procedure length, weight of tissue removed, and inferior pedicle technique all significantly increased as BMI increased ( P < 0.001). Higher BMI cohorts, especially class III, had significantly higher rates of surgical site infections (healthy: 0%, overweight: 1.1%, I: 1.4%, II: 0%, III: 15.8%, P < 0.01), fat necrosis (healthy: 1.2%, overweight: 5.1%, I: 7%, II: 0%, III: 22.2%, P = 0.01), dehiscence (healthy: 3.6%, overweight: 2.8%, I: 2.1%, II: 5.1%, III: 31.6%, P < 0.01), delayed healing (health: 4.8%, overweight: 11.2%, I: 16.9%, II: 28.2%, III: 42.1%, P < 0.01), minor T-point breakdown (healthy: 10.8%, overweight: 15.7%, I: 23.9%, II: 23.1%, III: 52.6%, P = 0.01), and surgical site occurrence requiring procedural intervention (healthy: 6.0%, overweight: 5.6%, I: 6.3%, II: 15.4%, III: 21.1%, P < 0.05). When compared to the other weight classes independently, class III was associated with unfavorable outcomes ( P < 0.05). Significant improvement in average postoperative QoL scores in satisfaction with breast, psychosocial well-being, sexual well-being, and physical well-being were seen in all cohorts except class III ( P < 0.05).
Conclusions: Severe obesity class III patients undergoing RM have a higher yet still acceptable risk profile and should be counseled on the risks despite its improved quality of life.
期刊介绍:
The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.