Risk Factors for Hematoma Development Post Reduction Mammaplasty: Novel Associations and Implications

Objectives: The aim of this retrospective study was to analyze various preoperative and intraoperative factors that may contribute to the development of wound hematoma after reduction mammaplasty. This will help us to estimate a prospective patient s individualized risk based on selected identifiable factors, facilitating patient selection and preoperative counseling.Methods: Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty over a 10- year period (1999-2008) performed by a single surgeon were studied. The following factors were addressed: age, medical history, medications, smoking habits, Body Mass Index (BMI), phase of menstrual cycle, mass of resection, prophylactic heparin, operation time, intraoperative blood loss, preoperative and postoperative Hemoglobin (Hb) and Hematocrit (Hct) levels, various blood pressure measurements and hematoma formation. The operative time was divided into two periods and in our experience, hemostasis was achieved in the second period.Results: In our series, six patients developed a postoperative wound hematoma; only two patients required operative evacuation (3%). Body Mass Index (BMI), mass of resection and subcutaneous prophylactic heparin significantly affected the likelihood of wound hematoma (P values: 0.018, 0.002 and 0.031, respectively). Smoking, age, medical illnesses and phase of menstrual cycle had no statistical significance on the development of wound hematoma. Logistic regression analysis showed that the peak systolic blood pressure during the period of hemostasis was significantly lower in patients who developed hematoma (P=0.019).Conclusions: Our data indicate that there was a significant correlation between post-operative hematoma and Body Mass Index (BMI), mass of resection, prophylactic heparin and intraoperative hypotention during the period of hemostasis.