Shifting the paradigm on tissue removal and postoperative complications in breast reduction: A systematic review and meta-analysis.

[BACKGROUND] The amount of tissue resection, measured in weight per breast, in breast reduction surgery has been considered a potential risk factor for complications.

[OBJECTIVE] We aimed to evaluate the effect of removing >1000 g versus <1000 g of breast tissue in women with macromastia.

[METHODS] A systematic search was performed on Pubmed, Embase, and Cochrane in March 2024 for studies that compared resection weight >1000 g versus <1000 g in reduction mammoplasty. Pooled odds ratios were computed for binary endpoints. We used R Studio for statistical analysis.

[RESULTS] We included 8 studies, with 1760 breasts, among which 493 (28.1%) had resection of ≥1000 g per breast. Women who had >1000 g of tissue resected per breast had lower risk of developing hypertrophic scar (OR 0.07; 95% CI 0.02-0.25; p < 0.001) and surgical site infection (OR 0.17, 95% CI 0.07-0.42, p < 0.001) than those who had <1000 g of breast resection. No statistical difference was observed among the groups for the outcomes of delayed wound healing and dehiscence, hematoma, fat or areolar necrosis, overall complications rates, and seroma.

[CONCLUSION] Among women who underwent reduction mammoplasty, resection of >1000 g of tissue per breast was associated with lower risk of hypertrophic scar development and surgical site infection than resection of <1000 g.