188. Trends In Body Mass Index, Overweight, and Obesity in Adolescents Undergoing Breast Reduction Surgery: Analysis of a Nationwide Database

PURPOSE: The rate of breast reduction for patients younger than eighteen years has surged in the last decade. This increase may be explained by increased insurance coverage, heightened awareness of the procedure, or increased willingness by surgeons to operate in this age group. Another possible contributor may be a concurrent increase in overall weight, which is correlated with macromastia. Despite many surgeons implementing BMI cutoffs for breast reductions, it is unclear whether or how often overweight or obese adolescents undergo the procedure. The authors examined a nationwide database to investigate these potential associations. METHODS: The National Surgical Quality Improvement Program Pediatric (NSQIP-Ped) database was queried for procedures performed in the United States between 2013 and 2022. Cases listed as “breast reduction”, “reduction mammaplasty”, or “mammaplasty reduction” were included in Group 1. Two comparison cohorts were generated and age-matched to Group 1: Group 2, comprised of patients (presumably otherwise healthy) undergoing appendectomy; and Group 3, comprised of patients undergoing procedures other than a breast reduction or appendectomy. Patients were excluded if height and weight data were not listed. Student’s t-test and chi-squared tests were used in statistical comparisons between groups and adjusted for multiple comparisons. RESULTS: Group 1 comprised of 2857 patients undergoing breast reduction, with a significant increase over the study period (64 cases in 2013 versus 682 cases in 2022, p<0.001). 12,066 patients had appendectomy (Group 2), while Group 3 totaled 96,762 procedures during the same time, with both having significant increases in annual cases, though smaller than that seen for Group 1 (Group 2: 680 in 2013 versus 1,991 in 2022, p<0.001; Group 3: 4,521 in 2013 versus 14,799 in 2022, p<0.001). Median BMI for breast reductions (Group 1) was significantly higher than in Group 2 or 3, averaging 7.0 points higher over the study period. Percentage of patients overweight (BMI between 25 and 30), obese (BMI>30), and morbidly obese (BMI>40) were all significantly higher for the breast reduction group than either comparison group (p<0.001). No significant correlation was found between year of study and either BMI or rate of obesity for any of the three groups. CONCLUSION: These data suggest that adolescent patients undergoing breast reduction have higher BMI and higher rates of obesity than patients undergoing other surgical procedures. Nevertheless, BMI and rates of obesity are not increasing among pediatric patients undergoing breast reduction, suggesting that rising BMI is not a major driver of the recent increase in breast reductions. Further studies are required to assess why rates of pediatric breast reductions are increasing.