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South Med J. Author manuscript; available in PMC 2020 December 29.
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Published in final edited form as:

South Med J. 2017 October ; 110(10): 660–666. 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, M. Catherine Lee, MD
Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and
Cancer Institute, Tampa, Florida

Abstract
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Background: Breast-conserving surgery with adjuvant radiation therapy (BCT) has been
established as safe oncologically. 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 medical 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, clinical and pathological information, and data on postoperative complications within 6
months stratified 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
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to completion mastectomy. The overall complication rate was 33.9% (n = 20): 12 major (20.3%)
and 8 minor (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 (stratified body mass index, prior breast surgery, hypertension, diabetes mellitus,
hyperlipidemia, vascular disease, pulmonary disease, and stratified weight of tissue removed),
none were associated with overall or major complications. Pulmonary disease was associated with
minor complications (P = 0.03). Bilateral versus unilateral oncoplastic breast reduction showed no
statistically significant 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
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reconstruction. No risk factors were associated with major or overall complications. Age and
pulmonary disease were associated with minor complications. Patients should be selected and
counseled appropriately when considering oncoplastic breast reduction.

Correspondence to Dr M. Catherine Lee, NEED BUILDING NAME, 109201 N McKinley Dr, Tampa, FL 33612.
M.Catherine.Lee@moffitt.org.
M.C.L. has received compensation from Up-To-Date and Genomic Health. The remaining authors did not report any financial
relationships or conflicts of interest.
 Mattingly et al. Page 2

Keywords
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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 surgery with adjuvant radiation therapy (BCT) and demonstrated equivalent
overall survival, even after 20 years of follow-up.1 The National Surgical Adjuvant Breast
and Bowel Project B-06 trial randomly 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
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alone cohort, and the benefit of radiation was independent 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 cancer 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
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(ASTRO) Consensus Guidelines define negative margin as no invasive carcinoma on ink.5

Positive margins are associated with a doubled risk of ipsilateral breast tumor recurrence
compared with negative margins, regardless of tumor biology or radiation boost; however,
wider margins do not decrease recurrence.5 Poor aesthetic outcome after BCT has been
reported to be as high as 6.5%, with 29% reporting an intermediate 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

Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for breast
conservation to improve aesthetic outcomes. Oncoplastic breast surgery can be a broad term
encompassing many surgical techniques.8 We focused on the breast volume displacement
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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 reduced 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.

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A systematic review of the literature for oncoplastic breast surgery evaluated oncologic and
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aesthetic 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 assessment 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 outcomes after BCT, 94% of patients
undergoing oncoplastic breast surgery were satisfied or extremely 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
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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
aesthetic 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%) compared 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 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
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bilateral mastectomy, oncoplastic breast surgery often includes contralateral reduction

mammoplasty for symmetry, which theoretically could increase wound complications by
doubling the surgical sites. NSQIP data estimate early postoperative complications for
bilateral mastectomy to be approximately 21.2% and 14.7% for unilateral mastectomy.11 As
the literature 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
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breast conservation 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 diagnosis 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.

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All of the patients were treated by a fellowship-trained breast surgical oncologist, with the
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majority 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 surgeon. Each patient underwent evaluation of medical comorbidities and standard
preoperative assessment 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 status, 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 hospitalization. Examples
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include seroma or hematoma requiring aspiration/percutaneous drain placement, operative

debridement, or cosmesis requiring operative revision. Minor complications included 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,
hyperlipidemia, 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 of breast tissue removed (<500 g, 500–1000 g, >1000 g) as
categorical variables. Categorical variables were analyzed using the χ2 exact method.
Continuous variables included age, BMI, and weight of breast tissue removed, which were
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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 extent 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%)
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patients.

Table 1 summarizes the clinical and pathologic features. The most common comorbidity was
obesity, 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,

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range 39.8–2617.0). Of note, some procedures did include additional smaller specimens that
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were not weighed but may have increased total volume of tissue removed. Of the 59 patients,
8 had unilateral oncoplastic reduction, whereas 51 had oncoplastic breast reduction with
simultaneous contralateral reduction mammoplasty. 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.

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 disease with unilateral invasive ductal carcinoma and contralateral invasive lobular
carcinoma tallied separately. For this patient, receptors, margins, clips for radiation therapy,
and completion of radiation 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
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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 underwent unilateral oncoplastic
breast reduction (n = 8), 2 patients experienced a complication; 1 patient 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 complications (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%.

For each variable, patients without complications were compared (n = 39) with those with
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any complications (n = 20), those with major complications (n = 12), and those with minor
complications (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 bilateral 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 =
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0.12). None were associated with overall or major complications. Pulmonary disease
(including emphysema and obstructive sleep apnea) was associated 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 association
with major complications (P = 0.13) but, again, not with minor (P = 0.64) or overall
complications P = 0.66). Complications (major and minor) were evenly split between
cancer-affected breast and unaffected breast procedures.

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Discussion
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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 outcomes 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 reoperations and improve aesthetic outcomes in breast cancer,12
noting oncoplastic techniques as having 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 placement for radiation planning.12 Few
publications, however, evaluate the complication rates associated with these procedures. We
did examine our data compared with other published series and national databases in
interpreting our results.
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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, including hypertension, increased age, and elevated BMI. This likely is only a
marker of general medical 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
cohort. Two other small singleinstitution retrospective series also have suggested major
complication rates of approximately 22% among oncoplastic reduction cases, which is
similar to our findings.13,14
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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 potential 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 recommended considering clip placement, clips were placed
in only 60% of patients in this series because of unreliable clip positioning after tissue
rearrangement, making the clips useless for radiation 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
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mellitus, smoking status, and an American Society of Anesthesiologists (ASA) score of 3 or

4 were significant predictors of postoperative complications.10 ASA score also is likely a
marker of medical morbidity, similar to our patients identified as having pulmonary disease.
Among the patients with pulmonary comorbidities, 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

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associated with any complications, although diabetes mellitus did trend toward an
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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 versus 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 benign group, although BMI was a significant predictor of
complications for either group.14 Our oncoplastic 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
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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 patients 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 unilateral mastectomy (0.7%) group (P = 0.015).11 Similarly,
BCT is limited to one breast, whereas oncoplastic breast reduction often involves bilateral
breasts because of contralateral reduction mammoplasty for symmetry. Among unilateral
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oncoplastic breast reduction patients (n = 8), the complication 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 important to note that there are significant differences
between the populations that limit comparisons; in particular, a majority of patients who
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underwent bilateral mastectomy/immediate reconstruction 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 reduction 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

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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
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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, including BMI and diabetes mellitus, were associated with major
or overall complications. Age and pulmonary 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
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breast reduction.

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.

References
1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing
breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med
2002;347:1227–1232. [PubMed: 12393819]
2. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total
mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast
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cancer. N Engl J Med 2002;347:1233–1241. [PubMed: 12393820]

3. National Institutes of Health. Treatment of early-stage breast cancer. https://consensus.nih.gov/
1990/1990earlystagebreastcancer081html.htm. Accessed March 21, 2016.
4. Bellon JR, Harris EE, Arthur DW, et al. ACR Appropriateness Criteria® conservative surgery and
radiation—stage I and II breast carcinoma: expert panel on radiation oncology: breast. Breast J
2011;17:448–455. [PubMed: 21790842]
5. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for
Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-
breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys
2014;88:553–564. [PubMed: 24521674]
6. Foersterling E, Golatta M, Hennigs A, et al. Predictors of early poor aesthetic outcome after breast-
conserving surgery in patients with breast cancer: initial results of a prospective cohort study at a
single institution. J Surg Oncol 2014;110:801–806. [PubMed: 25132148]
7. Vos EL, Koning AH, Obdeijn IM, et al. Preoperative prediction of cosmetic results in breast
conserving surgery. J Surg Oncol 2015;111:178–184. [PubMed: 25332158]
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8. Haloua MH, Krekel NM, Winters HA, et al. A systematic review of oncoplastic breast-conserving
surgery: current weaknesses and future prospects. Ann Surg 2013;257:609–620. [PubMed:
23470508]
9. Santos G, Urban C, Edelweiss MI, et al. Long-term comparison of aesthetical outcomes after
oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol 2015;22:2500–2508.
[PubMed: 25519931]
10. Pyfer B, Chatterjee A, Chen L, et al. Early postoperative outcomes in breast conservation surgery
versus simple mastectomy with implant reconstruction: a NSQIP analysis of 11,645 patients. Ann
Surg Oncol 2016;23:92–98. [PubMed: 26219243]

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11. Silva AK, Lapin B, Yao KA, et al. The effect of contralateral prophylactic mastectomy on
perioperative complications in women undergoing immediate breast reconstruction: a NSQIP
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analysis. Ann Surg Oncol 2015;22:3474–3480. [PubMed: 26001862]

12. Landercasper J, Attai D, Atisha D, et al. Toolbox to reduce lumpectomy reoperations and improve
cosmetic outcome in breast cancer patients: the American Society of Breast Surgeons Consensus
Conference. Ann Surg Oncol 2015;22:3174–3183. [PubMed: 26215198]
13. Munhoz AM, Aldrighi CM, Montag E, et al. Outcome analysis of immediate and delayed
conservative breast surgery reconstruction with mastopexy and reduction mammaplasty
techniques. Ann Plast Surg 2011;67: 220–225. [PubMed: 21301307]
14. Imahiyerobo TA, Pharmer LA, Swistel AJ, et al. A comparative retrospective analysis of
complications after oncoplastic breast reduction and breast reduction for benign macromastia: are
these procedures equally safe? Ann Plast Surg 2015;75:370–37. [PubMed: 24691307]
15. Boughey JC, Hieken TJ, Jakub JW, et al. Impact of analysis of frozen-section margin on
reoperation rates in women undergoing lumpectomy for breast cancer: evaluation of the National
Surgical Quality Improvement Program data. Surgery 2014;156:190–197. [PubMed: 24929768]
16. Kim MK, Kim T, Moon HG, et al. Effect of cosmetic outcome on quality of life after breast cancer
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surgery. Eur J Surg Oncol 2015;41:426–432. [PubMed: 25578249]

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Key Points
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• 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
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breast-conserving surgery with adjuvant radiation therapy.

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Fig.
Preoperative, immediately postoperative, and 1-year postoperative photographs of bilateral
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oncoplastic reduction.
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Table 1.

Summary of clinical and pathologic features

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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
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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
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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
Progesterone receptor positive 46 76.7
HER2/neu positive 3 5.0
N/A 5 8.3
Specimen weight, g, n = 101
<500 37 36.6
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500–1000 37 37.6
>1000 26 25.7
Margin status, n = 60
Positive 4 6.7
Negative 56 93.3

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N %
Adjuvant radiation therapy, n = 60
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Clips placed at surgery 36 60.0

Radiation declined 3 5.0
Radiation completed 51 85.0
Radiation N/A 6 10.0

ASA, American Society of Anesthesiologists; BMI, body mass index; HER2, human epidermal growth factor receptor 2; N/A, not applicable.
a
American Society of Anesthesiologists classification.
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Table 2.

Summary of early postoperative complications, n = 59

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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
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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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Table 3.

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

Complications
Mattingly et al.

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

South Med J. Author manuscript; available in PMC 2020 December 29.

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Table 4.

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

Complications
Mattingly et al.

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 a
0.03

BMI, body mass index.

a
Statistically significant.

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