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 2016-2022 were included. BMI cohorts were formed according to CDC guidelines: Healthy (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class I (30-34.9 kg/m2), II (35-39.9 kg/m2) and III (> 40 kg/m2). QoL was assessed by comparing pre- 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 (SSI) (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.