Obesity and early complications after reduction mammaplasty in women aged 60 years or older: a retrospective cohort study

Abstract Background Obesity is an established risk factor for wound complications after reduction mammaplasty, but outcome data for women aged 60 years or older, in whom obesity and age-related comorbidity frequently coexist, are limited. Objectives To compare early and late outcomes after reduction mammaplasty between obese and non-obese women aged 60 years or older. Methods This retrospective single-centre cohort study included 286 women aged ≥ 60 years who underwent bilateral reduction mammaplasty between 2005 and 2024, stratified into obese (BMI ≥ 30 kg/m², n = 78) and non-obese (BMI < 30 kg/m², n = 208) groups. The primary endpoint was any complication requiring surgical intervention within 30 days. Secondary endpoints included any early complication, wound-related and systemic complications, operative time, blood loss, length of hospital stay and late reoperations. Results Median age was 64 years (range 60–76); 33 patients (11.5%) were aged ≥ 70 years, 97.4% of obese patients had class I obesity, and median follow-up was 3 months (range 0–67). The primary endpoint occurred in 3 obese (3.8%) and 5 non-obese patients (2.4%) (OR 1.62, 95% CI 0.38–6.96; p = 0.454). At least one early complication occurred in 20.5% and 8.7% of patients, respectively (OR 2.72, 95% CI 1.31–5.66; p = 0.012), mainly because of wound dehiscence (9.0% vs. 0.5%; p < 0.001). After adjustment for age, smoking and diabetes, obesity remained associated with early complications (adjusted OR 2.83, 95% CI 1.35–5.93; p = 0.006), as did BMI per kg/m² (adjusted OR 1.22, 95% CI 1.08–1.41). The association was attenuated after additional adjustment for resection weight (adjusted OR 1.99, 95% CI 0.86–4.52) and was confined to procedures performed in 2005–2014. Reoperation after 30 days did not differ significantly (9.0% vs. 4.8%; p = 0.259). Conclusion Among women aged 60 years or older, obesity was associated with approximately threefold higher odds of early complications after reduction mammaplasty, driven mainly by wound dehiscence, whereas complications requiring surgical intervention were uncommon and did not differ significantly between groups. Given the small number of events, short follow-up, attenuation after adjustment for resection weight and heterogeneity over time, these findings support individualized counselling and preoperative optimization rather than categorical exclusion of older obese patients. Level of Evidence: III