D10. Balancing the Scales: Caution In Breast Reduction Recommendations for Obesity Class III Patients

PURPOSE: We investigated whether obesity should be considered for breast reduction (BR) by examining the surgical outcomes and QoL across different weight classes, aiming to pinpoint when outcomes become less favorable. METHODS: Patients undergoing BR by two surgeons from 2016-2022 were included. BMI cohorts were formed according to CDC guidelines: obesity class I (30-34.9 kg/m2), obesity class II (35-39.9 kg/m2) and obesity class III (> 40 kg/m2). QoL was assessed by comparing pre- and postoperative BREAST-Q BR scores within cohorts. A comparison analysis was performed between weight classes (I vs II vs III, II vs III) RESULTS: 461 BR patients were identified (I: 142, II: 39, III: 19). As BMI increased, percentage of Black patients, procedure length, weight of tissue removed, and inferior pedicle technique all significantly increased (p<0.001). Obesity class III cohort had significantly higher rates of SSI (I: 1.4%, II: 0%, III: 15.8%, p<0.01), fat necrosis (I: 7%, II: 0%, III: 22.2%, p=0.01), dehiscence (I: 2.1%, II: 5.1%, III: 31.6%, p<0.01), minor T-point breakdown (I: 23.9%, II: 23.1%, III: 52.6%, p=0.01), and reoperations (I: 6.3%, II: 15.4%, III: 21.1%, p<0.05). When comparing class III to class I and class II 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<0.001). CONCLUSION: Counseling patients in obesity class III demands utmost caution, thoroughly weighing the risks and benefits before recommending breast reduction surgery.