Bitter-sweet? The role of glycemic control in breast reduction surgery

The American Society of Plastic Surgeons guidelines emphasize the need for additional evidence regarding perioperative glycemic control in patients with diabetes undergoing breast reduction surgery. This study evaluates the association between preoperative hemoglobin A1c (HbA1c) levels and postoperative complications in patients with diabetes undergoing reduction mammaplasty. A retrospective cohort study of the National Surgical Quality Improvement Program (NSQIP) database was performed, identifying patients diagnosed with diabetes who underwent breast reduction surgery from 2021 to 2023. Patients were stratified by preoperative HbA1c levels: well-controlled (HbA1c < 6.5%) versus poorly controlled (HbA1c ≥ 6.5%). Demographics, surgical characteristics, and 30-day postoperative outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent risk factors for complications. A total of 364 female patients with diabetes met the inclusion criteria, of whom 293 (80%) had non–insulin-dependent and 71 (20%) had insulin-dependent diabetes. Based on HbA1c levels, 206 patients (57%) had well-controlled diabetes, and 158 (43%) had poorly controlled diabetes. The groups were comparable in age, BMI, and surgical characteristics. The overall complication rate was 10.7% (n = 39), with superficial surgical site infections being the most common (n = 22, 6.0%). Patients with poorly controlled diabetes had higher rates complications overall (13.0% vs. 9.2%, p = 0.29) and readmission (4.4% vs. 1.0%, p = 0.044). In multivariable analysis, HbA1c ≥ 6.5% was independently associated with an increased risk of complications (OR 2.2, 95% CI 1.0–4.7, p = 0.047). Patients with diabetes and poorly controlled glycemic status demonstrate a higher likelihood of postoperative complications following breast reduction surgery, although the association reached only borderline statistical significance. These findings support the clinical plausibility that suboptimal glycemic control may contribute to increased perioperative risk and may help inform patient counseling and surgical decision-making in this population. Further research is needed to clarify the extent to which preoperative glycemic optimization influences outcomes in this population.