{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:35:49Z","timestamp":1784000149270,"version":"3.55.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cosmetic breast surgery (CBS) can be subdivided into augmentation, mastopexy, reduction, and reconstruction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The aim of this study was to retrospectively analyze a multi-institutional national database to investigate the outcomes of CBS and identify clinical patterns to optimize care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The American College of Surgeons National Surgical Quality Improvement Program database (2008-2020) was reviewed to identify female patients who underwent CBS. Postoperative outcomes (30-day surgical and medical complications, reoperation, readmission, and mortality) and risk factors for complications were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 4733 patients were identified (mean age, 40 [13] years; mean BMI, 24 [4.5] kg\/m2) with augmentation accounting for 54% of cases. There were complications in 2.0% of cases. Age &amp;gt;65 years (P = .002), obesity (P &amp;lt; .0001), setting (P &amp;lt; .0001), and diabetes (P = .04) were risk factors for any complication. Age &amp;gt;65 years (P = .02), obesity (P = .03), diabetes (P = .01), history of chronic obstructive pulmonary disease (COPD) (P = .002) and congestive heart failure (P &amp;lt; .0001), smoking in the past year (P = .003), setting (P = .007), and increased American Society of Anesthesiology score (P &amp;lt; .0001) were predictors of surgical complications such as dehiscence and infection. Multivariable analysis confirmed that chronic obstructive pulmonary disease, obesity Class 1 and 3, and inpatient status were independent risk factors for occurrence of any complication (P = .0005, .0003, &amp;lt; .0001 and &amp;lt;.0001, respectively). Additionally, multiple procedures (P = .02) and smoking (P = .005) were found to be risk factors for surgical complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study confirms the positive safety profile of CBS. Healthy BMI is a protective factor, while complications were more likely among inpatient procedures. A correlation between multiple procedures and increased surgical complications was identified. Awareness of these risk factors can assist surgeons to further refine their perioperative protocols.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjac320","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T23:25:54Z","timestamp":1670369154000},"page":"433-451","source":"Crossref","is-referenced-by-count":30,"title":["Perioperative Outcomes and Risk Profile of 4730 Cosmetic Breast Surgery Cases in Academic Institutions: An ACS-NSQIP Analysis"],"prefix":"10.1093","volume":"43","author":[{"given":"Samuel","family":"Knoedler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kauke-Navarro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2964-979X","authenticated-orcid":false,"given":"Valentin","family":"Haug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P Niclas","family":"Broer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bohdan","family":"Pomahac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Knoedler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4053-9855","authenticated-orcid":false,"given":"Adriana C","family":"Panayi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,6]]},"reference":[{"key":"2023070705143755500_sjac320-B1"},{"issue":"6","key":"2023070705143755500_sjac320-B2","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1097\/PRS.0b013e3182a80880","article-title":"Evidence-based medicine: augmentation mammaplasty","volume":"132","author":"Lista","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2023070705143755500_sjac320-B3","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1093\/asj\/sjx181","article-title":"Mastopexy and mastopexy-augmentation","volume":"38","author":"Qureshi","year":"2018","journal-title":"Aesthet Surg J"},{"issue":"6","key":"2023070705143755500_sjac320-B4","first-page":"424","article-title":"Breast reconstruction: updated overview for primary care physicians","volume":"64","author":"Somogyi","year":"2018","journal-title":"Can Fam Physician"},{"issue":"5","key":"2023070705143755500_sjac320-B5","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1055\/s-0038-1627449","article-title":"Impact of obesity on outcomes in breast reconstruction: a systematic review and meta-analysis","volume":"34","author":"Panayi","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"4","key":"2023070705143755500_sjac320-B6","first-page":"280","article-title":"Breast reconstruction","volume":"35","author":"Kaya","year":"2013","journal-title":"Exp Oncol"},{"issue":"1","key":"2023070705143755500_sjac320-B7","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.suc.2011.11.006","article-title":"The role of unconscious bias in surgical safety and outcomes","volume":"92","author":"Santry","year":"2012","journal-title":"Surg Clin North Am"},{"issue":"5","key":"2023070705143755500_sjac320-B8","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1093\/asj\/sjw238","article-title":"Aesthetic breast surgery and concomitant procedures: incidence and risk factors for major complications in 73,608 cases","volume":"37","author":"Gupta","year":"2017","journal-title":"Aesthet Surg J"},{"issue":"8","key":"2023070705143755500_sjac320-B9","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1055\/s-0043-114427","article-title":"Should breast cancer surgery be done in an outpatient setting? Health economics from the perspective of service providers","volume":"77","author":"Formago","year":"2017","journal-title":"Geburtshilfe Frauenheilkd"},{"issue":"3","key":"2023070705143755500_sjac320-B10","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1007\/s00266-017-1010-0","article-title":"Reductive augmentation of the breast","volume":"42","author":"Chasan","year":"2018","journal-title":"Aesthetic Plast Surg"},{"issue":"2","key":"2023070705143755500_sjac320-B11","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/asj\/sjx104","article-title":"Current trends in breast augmentation: an international analysis","volume":"38","author":"Heidekrueger","year":"2018","journal-title":"Aesthet Surg J"},{"issue":"9","key":"2023070705143755500_sjac320-B12","doi-asserted-by":"publisher","first-page":"2941","DOI":"10.1016\/j.bjps.2022.04.035","article-title":"The modified 5-item frailty index is a predictor of perioperative risk in breast reconstruction: an analysis of 40,415 cases","volume":"75","author":"Panayi","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"3","key":"2023070705143755500_sjac320-B13","doi-asserted-by":"publisher","first-page":"499e","DOI":"10.1097\/prs.0000000000006545","article-title":"Outpatient reduction mammaplasty offers significantly lower costs with comparable outcomes: a propensity score-matched analysis of 18,780 cases","volume":"145","author":"Calotta","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"12","key":"2023070705143755500_sjac320-B14","first-page":"967","article-title":"Advantages of outpatient breast surgery","volume":"60","author":"McManus","year":"1994","journal-title":"Am Surg"},{"issue":"6","key":"2023070705143755500_sjac320-B15","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1007\/bf00449254","article-title":"Reduction mammaplasty: a safe and effective outpatient procedure","volume":"20","author":"Short","year":"1996","journal-title":"Aesthetic Plast Surg"},{"issue":"2","key":"2023070705143755500_sjac320-B16","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1097\/00000637-199602000-00010","article-title":"Outpatient reduction mammaplasty: a review of 338 consecutive cases","volume":"36","author":"Buenaventura","year":"1996","journal-title":"Ann Plast Surg"},{"issue":"2","key":"2023070705143755500_sjac320-B17","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.asj.2008.01.001","article-title":"Outpatient reduction mammaplasty: an eleven-year experience","volume":"28","author":"Stevens","year":"2008","journal-title":"Aesthet Surg J"},{"issue":"3","key":"2023070705143755500_sjac320-B18","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1007\/s00266-019-01318-4","article-title":"Combined breast reduction augmentation","volume":"43","author":"Manero","year":"2019","journal-title":"Aesthetic Plast Surg"},{"key":"2023070705143755500_sjac320-B19","doi-asserted-by":"publisher","first-page":"ojab052","DOI":"10.1093\/asjof\/ojab052","article-title":"BreastGAN: artificial intelligence-enabled breast augmentation simulation","volume":"4","author":"Chartier","year":"2022","journal-title":"Aesthet Surg J Open Forum"},{"issue":"5","key":"2023070705143755500_sjac320-B20","doi-asserted-by":"publisher","first-page":"849e","DOI":"10.1097\/prs.0000000000001238","article-title":"Combined breast surgery and abdominoplasty: strategies for success","volume":"135","author":"Matarasso","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2023070705143755500_sjac320-B21","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.asj.2004.04.005","article-title":"\u201cExtreme\u201d cosmetic surgery: a retrospective study of morbidity in patients undergoing combined procedures","volume":"24","author":"Stevens","year":"2004","journal-title":"Aesthet Surg J"},{"issue":"5","key":"2023070705143755500_sjac320-B22","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1177\/1090820X14531434","article-title":"One-stage augmentation mastopexy: a review of 1192 simultaneous breast augmentation and mastopexy procedures in 615 consecutive patients","volume":"34","author":"Stevens","year":"2014","journal-title":"Aesthet Surg J"},{"issue":"2","key":"2023070705143755500_sjac320-B23","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1093\/asj\/sjw138","article-title":"Is office-based surgery safe? Comparing outcomes of 183,914 aesthetic surgical procedures across different types of accredited facilities","volume":"37","author":"Gupta","year":"2017","journal-title":"Aesthet Surg J"},{"issue":"suppl_2","key":"2023070705143755500_sjac320-B24","doi-asserted-by":"publisher","first-page":"S62","DOI":"10.1093\/asj\/sjx150","article-title":"Preliminary 3-year evaluation of experience with SilkSurface and VelvetSurface Motiva silicone breast implants: a single-center experience with 5813 consecutive breast augmentation cases","volume":"38","author":"Sforza","year":"2017","journal-title":"Aesthet Surg J"},{"issue":"5","key":"2023070705143755500_sjac320-B25","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1007\/s00266-007-0162-8","article-title":"A retrospective analysis of 3,000 primary aesthetic breast augmentations: postoperative complications and associated factors","volume":"31","author":"Araco","year":"2007","journal-title":"Aesthetic Plast Surg"},{"issue":"5","key":"2023070705143755500_sjac320-B26","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1097\/SAP.0b013e3181cdabf8","article-title":"Evaluation of preoperative risk factors and complication rates in cosmetic breast surgery","volume":"64","author":"Hanemann","year":"2010","journal-title":"Ann Plast Surg"},{"issue":"2","key":"2023070705143755500_sjac320-B27","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s00423-016-1392-5","article-title":"Low complication rate and an increasing incidence of surgical repair of primary indirect sliding inguinal hernia","volume":"401","author":"Hall\u00e9n","year":"2016","journal-title":"Langenbeck's Arch Surg"},{"issue":"6","key":"2023070705143755500_sjac320-B28","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1097\/PRS.0000000000001265","article-title":"Antibiotic prophylaxis for preventing surgical site infection in plastic surgery: an evidence based consensus conference statement from the American Association of Plastic Surgeons","volume":"135","author":"Ariyan","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"2023070705143755500_sjac320-B29","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.yasu.2016.03.007","article-title":"Strategies to reduce postoperative urinary tract infections","volume":"50","author":"Papageorge","year":"2016","journal-title":"Adv Surg"},{"key":"2023070705143755500_sjac320-B30","doi-asserted-by":"publisher","first-page":"7268985","DOI":"10.1155\/2016\/7268985","article-title":"Risk factors for postoperative urinary tract infections in patients undergoing total joint arthroplasty","volume":"2016","author":"Alvarez","year":"2016","journal-title":"Adv Orthop"},{"issue":"8","key":"2023070705143755500_sjac320-B31","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1177\/1090820X13508131","article-title":"The impact of body mass index on reduction mammaplasty: a multicenter analysis of 2492 patients","volume":"33","author":"Gust","year":"2013","journal-title":"Aesthet Surg J"},{"issue":"6","key":"2023070705143755500_sjac320-B32","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1097\/01.prs.0000160695.33457.db","article-title":"Analysis of breast reduction complications derived from the BRAVO study","volume":"115","author":"Cunningham","year":"2005","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"2023070705143755500_sjac320-B33","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.bjps.2007.10.043","article-title":"Obesity and complications in breast reduction surgery: are restrictions justified?","volume":"62","author":"Set\u00e4l\u00e4","year":"2009","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"4","key":"2023070705143755500_sjac320-B34","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/j.bjps.2010.07.001","article-title":"Obesity in mammaplasty: a study of complications following breast reduction","volume":"64","author":"Shah","year":"2011","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"5","key":"2023070705143755500_sjac320-B35","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1016\/j.surg.2016.11.028","article-title":"Standardizing the complication rate after breast reduction using the Clavien-Dindo classification","volume":"161","author":"Winter","year":"2017","journal-title":"Surgery"},{"issue":"1 Suppl","key":"2023070705143755500_sjac320-B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/01.prs.0000294705.85848.cf","article-title":"MOC-PSSM CME article: breast reduction","volume":"121","author":"Nahai","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"9","key":"2023070705143755500_sjac320-B37","doi-asserted-by":"publisher","first-page":"e1470","DOI":"10.1097\/gox.0000000000001470","article-title":"Breast reduction: decreasing complications and improving long-term aesthetic results with parenchymal sutures","volume":"5","author":"Hudson","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"2023070705143755500_sjac320-B38","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.breast.2017.10.009","article-title":"Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study","volume":"37","author":"Yoon","year":"2018","journal-title":"Breast"},{"issue":"5","key":"2023070705143755500_sjac320-B39","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.ajic.2008.12.010","article-title":"Surgical site infection: incidence and impact on hospital utilization and treatment costs","volume":"37","author":"De Lissovoy","year":"2009","journal-title":"Am J Infect Control"},{"issue":"2","key":"2023070705143755500_sjac320-B40","doi-asserted-by":"publisher","first-page":"258e","DOI":"10.1097\/prs.0000000000003506","article-title":"The Baltodano Breast Reduction Score: a nationwide, multi-institutional, validated approach to reducing surgical-site morbidity","volume":"140","author":"Baltodano","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2023070705143755500_sjac320-B41","first-page":"212","article-title":"Reducing surgical site infections: a review","volume":"2","author":"Reichman","year":"2009","journal-title":"Rev Obstet Gynecol"},{"issue":"5","key":"2023070705143755500_sjac320-B42","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1016\/j.bjps.2020.10.045","article-title":"Combined (endo-)vascular intervention and microsurgical lower extremity free flap reconstruction\u2014a propensity score matching analysis in 5386 ACS-NSQIP patients","volume":"74","author":"Haug","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"1","key":"2023070705143755500_sjac320-B43","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.jamcollsurg.2009.09.031","article-title":"Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program","volume":"210","author":"Shiloach","year":"2010","journal-title":"J Am Coll Surg"},{"issue":"6","key":"2023070705143755500_sjac320-B44","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1016\/j.bjps.2022.01.001","article-title":"Racial disparities in short-term outcomes after breast reduction surgery\u2014a National Surgical Quality Improvement Project Analysis with 23,268 patients using propensity score matching","volume":"75","author":"Haug","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjac320\/49138787\/sjac320.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/43\/4\/433\/50835149\/sjac320.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/43\/4\/433\/50835149\/sjac320.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T05:14:52Z","timestamp":1688706892000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/article\/43\/4\/433\/6874000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,6]]},"references-count":44,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,12,6]]},"published-print":{"date-parts":[[2023,3,15]]}},"URL":"https:\/\/doi.org\/10.1093\/asj\/sjac320","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,1]]},"published":{"date-parts":[[2022,12,6]]}}}