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 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 non-diabetic 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=1,261) had diabetes. Among diabetic patients, 83% (n=1,046) had DM-ORAL and 17% (n=215) DM-INS. Compared to non-diabetic patients, those with diabetes were significantly older (49.8±13.0 vs. 39.0±14.5 years; p<0.0001), had a higher body mass index (31.5±11.2 vs. 28.4±10.0 kg/m²; p<0.0001), 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 (OR 1.9; p=0.001), surgical complications (OR 1.6; p=0.04), medical complications (OR 3.1; p=0.02), and unplanned readmission (OR 4.9; p<0.0001). In contrast, DM-ORAL did not correlate with an increased risk of postoperative complications (OR 1.1; p=0.6). 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.