Complications Statistical Review

In 1999 Lejour [22] reported her personal series of 250 consecutive patients who had vertical mammaplasties during an 8-year period. This series included breast reductions on 324 breasts and mastopexies on 152 breasts. There was a wide range of breast sizes including: 42% between 100 and 500 g, 24% between 500 and 800 g, and 34% over 800 g. The overall complication rate consisted of 5% seroma, 1.3% hematoma, 0.4% infection, 0.4% partial areola necrosis, and 5.5% delayed wound healing. These figures were very similar to those reported by Lejour [15] in her 1994 book. Lejour also recognized that healing complications were the main problem following mammaplasty and showed the close relationship of obesity and large breast size to delayed healing. She even recommended that other reduction techniques be chosen in reductions greater than 1000 g, especially in the obese and elderly.

Recently, in 2003,Berthe et al. [21] published an interesting study in which 170 consecutive patients (330 breasts) underwent the classic Lejour mammaplasty technique from 1991 to 1994. Minor complications, which included seroma, hematoma, partial areola necrosis, and superficial wound dehiscence, were observed in 30 % of patients. Major complications, comprising glandular necrosis, total areola necrosis, and glandular infection, were seen in 15 % of patients. A surgical revision rate of 28% was necessary in this series. Noting these unacceptably high complication rates, Berthe et al. modified their technique by limiting breast liposuction to the axillary area in large breasts and minimizing skin undermining. Similar modifications have been described by Hall-Findlay [19]. Berthe et al. also performed primary skin excision in the inframammary fold if the excess could not be gathered adequately. The second part of this study, between 1996 and 1999, consisted of 138 consecutive patients (227 breasts) who underwent this modified technique. Minor complications dropped to 15% and major complications were lowered to 5%, thus demonstrating the importance of careful handling of the tissues. The revision rate in the second part of this study was 22%, which showed that the addition of a "primary" horizontal scar did not significantly improve the revision rate.

Other notable studies include a 1993 article by Pickford and Boorman [27]. Using the Lejour tech-nique,they reported 40 % minor complications, which included wound infection, fat necrosis, and delayed wound healing. A revisional surgery rate of 20 % was also noted. In 1997, Leone et al.[17] reported 16 % seroma, 9 % infection, 5 % hematoma, 16 % revision rate, and 18% major complications. Palumbo [18], also using the Lejour technique, reported in 1998 a delayed healing incidence of 6% and a revision rate of 7%.

When reviewing these studies demonstrating elevated rates of complications and delayed healing we must keep our perspective. Attention should also be focused on the fact that these same levels of complications are observed with Wise pattern mammaplasty techniques. In 1984, McKissock [23] noted that skin loss and delayed healing at the "junction of the T"was common. In 1995, Davis et al. [24] reported a 53% complication rate and 19 % delayed healing in a retrospective study of 406 reduction patients. In a series of 363 patients, Schnur et al. [26] in 1997 reported a 20% complication rate with Wise pattern reductions. Another article by Makki and Ghanem [25] in 1998

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