Sugar-Coated Complications? The Impact of Diabetes on Outcomes of Breast Reduction.

[BACKGROUND] Breast reduction surgery effectively alleviates symptoms of macromastia, but the impact of diabetes on surgical outcomes remains insufficiently studied.

[OBJECTIVES] The authors of this study aim to evaluate the effect of diabetes, stratified by treatment modality, on postoperative outcomes following breast reduction surgery.

[METHODS] The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried (2017-2023) to identify female patients undergoing breast reduction. Patients were classified as nondiabetic or diabetic, with the latter further stratified into diabetes mellitus treated with oral agents (DM-ORAL) or with insulin (DM-INS). Preoperative characteristics and 30-day postoperative outcomes were compared, and multivariable confounder-adjusted regression analyses were performed.

[RESULTS] The cohort included 29,346 female patients, of whom 4.3% (n = 1261) had diabetes. Among diabetic patients, 83% (n = 1046) had DM-ORAL and 17% (n = 215) DM-INS. Compared with nondiabetic patients, those with diabetes were significantly older (49.8 ± 13.0 vs 39.0 ± 14.5 years; P < .0001), had a higher body mass index (31.5 ± 11.2 vs 28.4 ± 10.0 kg/m2; P < .0001), and exhibited a greater overall burden of comorbidities. Multivariable analysis revealed that DM-INS was associated with a significantly increased risk of overall adverse events (odds ratio [OR] 1.9; P = .001), surgical complications (OR 1.6; P = .04), medical complications (OR 3.1; P = .02), and unplanned readmission (OR 4.9; P < .0001). In contrast, DM-ORAL did not correlate with an increased risk of postoperative complications (OR 1.1; P = .6).

[CONCLUSIONS] DM-INS is associated with an increased perioperative risk following breast reduction surgery. These findings underscore the need for tailored perioperative strategies and support risk-specific guidelines in this population.